Office of House Bill AnalysisH.B. 1676
By: Burnam


Traumatic brain injury (TBI) is an insult to the brain, not of degenerative
or congenital nature, caused by an external force that may produce a
diminished or altered state of consciousness, which results in an
impairment of cognitive abilities or physical functioning. According to the
Brain Injury Association of Texas, TBI is the leading cause of death and
disability among children and young adults. Each year, approximately 20,000
Texans sustain a TBI serious enough to require hospitalization with more
than 3,000 of these injuries resulting in death. Survivors of a TBI can
lead full lives thanks to lifesaving medical techniques and rehabilitation
services. However, survivors of a TBI face a long rehabilitation process
that may not be covered by certain health benefit plans. In some cases,
insurers exclude coverage of rehabilitation services as part of a health
benefit plan on the basis that a TBI is a mental illness and not a physical
illness. House Bill 1676 prohibits insurers from limiting or excluding
coverage for survivors of a TBI for necessary cognitive therapy,
neuropsychological testing or treatment, or community reintegration


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Sections 2 and 3, Article 21.53Q, Insurance Code) of this bill. 


House Bill 1676 amends the Insurance Code to prohibit a health benefit plan
from limiting or excluding coverage for cognitive therapy,
neuropsychological testing or treatment, or community reintegration
activities necessary as a result of a traumatic brain injury. The bill
requires the commissioner of insurance (commissioner) to adopt rules as
necessary to implement this prohibition. The bill requires the commissioner
by rule to require the issuer of a health benefit plan to provide to
personnel responsible for precertification of coverage under the plan
training designed to prevent precertification of required coverage from
being wrongly denied based on a determination that the benefits for which
precertification of coverage is requested are psychiatric benefits rather
than medical benefits. The bill specifies the health benefit plans to which
these provisions do and do not apply. 


September 1, 2001. The Act applies only to a health benefit plan delivered,
issued for delivery, or renewed on or after January 1, 2002.