TITLE: Relating to health benefit plan coverage of certain physical therapy services and the practice of physical therapy.

SUMMARY: Relating to health benefit plan coverage of certain physical therapy services and the practice of physical therapy.

FULL TEXT:
AN ACT relating to health benefit plan coverage of certain physical therapy services and the practice of physical therapy. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Subtitle E, Title 8, Insurance Code, is amended by adding Chapter 1381 to read as follows: CHAPTER 1381. PHYSICAL THERAPY COVERAGE Sec. 1381.001. DEFINITION. In this chapter, "physical therapy" has the meaning assigned by Section 453.001, Occupations Code. Sec. 1381.002. APPLICABILITY OF CHAPTER. (a) This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by: (1) an insurance company; (2) a group hospital service corporation operating under Chapter 842; (3) a health maintenance organization operating under Chapter 843; (4) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; (5) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; (6) a stipulated premium company operating under Chapter 884; (7) a fraternal benefit society operating under Chapter 885; (8) a Lloyd's plan operating under Chapter 941; or (9) an exchange operating under Chapter 942. (b) Notwithstanding any other law, this chapter applies to: (1) a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter Bof that chapter; (2) a standard health benefit plan issued under Chapter 1507; (3) a basic coverage plan under Chapter 1551; (4) a basic plan under Chapter 1575; (5) a primary care coverage plan under Chapter 1579; (6) a plan providing basic coverage under Chapter 1601; (7) nonprofit agricultural organization health benefits offered by a nonprofit agricultural organization under Chapter 1682; (8) alternative health benefit coverage offered by a subsidiary of the Texas Mutual Insurance Company under Subchapter M, Chapter 2054; (9) health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code; (10) group health coverage made available by a school district in accordance with Section 22.004, Education Code; (11) the state Medicaid program, including the Medicaid managed care program operated under Chapter 540, Government Code; (12) the child health plan program under Chapter 62, Health and Safety Code; (13) a regional or local health care program operated under Section 75.104, Health and Safety Code; (14) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code; (15) county employee group health benefits provided under Chapter 157, Local Government Code; and (16) health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code. Sec. 1381.003. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for inpatient physical therapy must provide coverage for services that are medically necessary to: (1) maintain existing physical function or restore, prevent the loss of, or slow the decline of physical function; or (2) reduce secondary health risks resulting from physical dysfunction. (b) A health benefit plan issuer may not deny coverage required by Subsection (a) on the basis that the service is not expected to produce an improvement in the physical function of the patient, including a patient recovering from a stroke or similar neurological condition. SECTION 2. Section 453.001(6), Occupations Code, is amended to read as follows: (6) "Physical therapy" means a form of health care that maintains existing physical function or prevents, identifies, corrects, [or] alleviates,or slows the progress of acute or prolonged movement dysfunction or pain of anatomic or physiologic origin. SECTION 3. Section 453.005(b), Occupations Code, is amended to read as follows: (b) The practice of physical therapy includes: (1) measurement or testing of the function of the musculoskeletal, neurological, pulmonary, or cardiovascular system; (2) rehabilitative treatment concerned with restoring function,maintaining existing function, or preventing or slowing the progress of disability caused by illness, injury, or birth defect; (3) treatment, consultative, educational, or advisory services to reduce the incidence or severity of disability or pain to enable, train, or retrain a person to perform the independent skills and activities of daily living; and (4) delegation of selective forms of treatment to support personnel while a physical therapist retains the responsibility for caring for the patient and directing and supervising the support personnel. SECTION 4. Chapter 1381, Insurance Code, as added by this Act, applies only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2026. SECTION 5. Chapter 453, Occupations Code, as amended by this Act, applies only to conduct that occurs on or after the effective date of this Act. Conduct that occurs before the effective date of this Act is governed by the law in effect on the date the conduct occurred, and the former law is continued in effect for that purpose. SECTION 6. This Act takes effect September 1, 2025.