HBA-NRS H.B. 1676 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1676 By: Burnam Insurance 3/23/2001 Introduced BACKGROUND AND PURPOSE 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 activities. RULEMAKING AUTHORITY 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. ANALYSIS 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. EFFECTIVE DATE September 1, 2001. The Act applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2002.