For this weekly feature, the Texas Council for Developmental Disabilities (TCDD) profiles a noteworthy bill that is currently going through the legislative process. The bill may relate directly to TCDD’s Public Policy Priorities or another disability-related issue.
Bill: House Bill (HB) 908, relating to health benefit plan coverage for early child intervention services.
Bill Author: Rep. Julie Johnson, House District 115 (Dallas County)
What does the bill do?
HB 908 would ensure that private health insurance plans are required to provide, rather than simply offer, coverage for early childhood intervention (ECI) services, thereby expanding the availability of rehabilitative and habilitative therapies for infants and toddlers.
Under the terms of the bill, the required benefits for infants and toddlers with disabilities or developmental delays would include the following:
- Occupational therapy evaluations and services
- Physical therapy evaluations and services
- Speech therapy evaluations and services
- Dietary or nutritional evaluations
- Specialized skills training by a certified ECI specialist
- Applied behavioral analysis treatment by a licensed behavioral analyst or psychologist
- Case management provided by a licensed practitioner of the healing arts or a certified ECI specialist
HB 908 would require health benefit plans to provide coverage for therapeutic services in the amount, duration, and scope established by the child’s individualized family service plan, with one exception: the bill would allow the health benefit plan to subject specialized skills training, including case management costs, to an annual limit of $9,000 for each child. Such limits would not be allowed for any of the other benefits listed above. Additionally, the bill would prohibit a health benefit plan from applying therapeutic visits to any annual limit of visits to a physician or health care. Any prior authorization requirements under the health benefit plan would be satisfied by a service’s inclusion in the child’s individualized family service plan.
HB 908 specifies that, to qualify for any state-provided ECI services, a child must exhaust all available coverage under these new requirements. This provision would be implemented in accordance with the Individuals with Disabilities Education Act (IDEA) – a federal law ensuring that all students with disabilities are provided with public education that is free and tailored to their specific needs – and the bill does not in any way reduce the state’s obligation under IDEA.
The terms of the bill would apply only to health benefit plans delivered, issued for delivery, or renewed on or after Jan. 1, 2022.
ECI is a statewide program administered by the Texas Health and Human Services Commission for families with children up to three years old with developmental delays, disabilities, or a qualifying medical diagnosis. ECI services support families as they gain the skills and resources needed to help their children grow and learn. By doing so, ECI promotes independence and self-determination for the child while instilling confidence in the family, which has long-term positive impacts.
Studies have found that children who participate in ECI services have less need for special education in the future, subsequently providing a return on investment from $2.50 to $17.07 for every dollar spent on early intervention services, according to the report “Advocating for Early Intervention in Tight Times” by Alison Whyte. However, an October 2020 federal investigation of the Texas ECI program determined that the state is in violation of federal law by under-enrolling infants and toddlers as a result of the state’s decrease in ECI funding over the last decade.
Unlike some states, Texas does not currently require private insurance companies to cover most ECI services. Consequently, Texas disproportionately relies on state and federal funds to cover costs of services for Texas children, including those with private insurance.
In the 86th legislative session, Texas lawmakers passed Rider 98, which requires ECI to explore ways to maximize its funding. Requiring private insurance to cover ECI services would seemingly align with requirements already passed by the state by freeing up state and federal funds used to cover uninsured ECI service costs.
Statement from the bill author, Rep. Julie Johnson:
“[HB 908] will maximize state resources to ensure Texas families can access early childhood interventions that prepare children for success in school, reduce the need for special education, and ultimately decrease long-term costs.”
Where is the bill in the process?
On Dec. 23, 2020, HB 908 was pre-filed for the 87th regular session. The bill is currently waiting to be referred to a committee.
Who supports the bill and why?
The following comments were taken from an April 16, 2019, public hearing of the House Committee on Insurance on a bill identical to HB 908:
- Texas Association for Behavior Analysis Public Policy Group: Kate Johnson-Patagoc, speaking on behalf of herself and the Texas Association for Behavior Analysis Public Policy Group: “The population of children is increasing in Texas but the per child ECI funding has been decreasing over recent years, causing many of the ECI providers to give up their contract with the state and causing delays to children receiving the services that they need. This bill would alleviate this problem by allowing private insurance to pay for ECI services… [this bill] would benefit Texas children with a developmental delay by allowing access to needed services, allowing these children to have a better quality of life, and decreasing the need for costly services in the future. It would not cost any additional dollars, and, in fact, it would save dollars down the line.”
The following groups also registered their support for the legislation without providing testimony: the Autism Society of Texas, Texans for Special Education Reform, the Center for Public Policy Priorities (now known as Every Texan), the National Association of Social Workers, the National Alliance on Mental Illness (NAMI) Texas, NAMI Austin, the Children’s Hospital Association of Texas, the Texas Council of Community Centers, Texas Parent to Parent, the Coalition of Texans with Disabilities, the Texas Association of Health Underwriters, Easterseals Central Texas, United Way of Texas, the Texas Academy of Family Physicians, the Texas Medical Association, and the Texas Pediatric Society.
Who opposes the bill and why?
During the 2019 hearing, the following groups registered their opposition but did not provide testimony: the Texas Association of Business, the Texas Association of Health Plans, and the National Federation of Independent Business.
According to the House Research Organization’s 2019 bill analysis (PDF), opponents believed that a bill identical to HB 908 would create another mandate for health insurance plans by requiring them to cover certain rehabilitative services for children, which would increase the health plan costs. These costs could be passed on to other consumers through higher premiums.
Though TCDD takes no formal position on HB 908, the Council lists the topic of ECI services among its 2021 Public Policy Priorities. That priority reads as follows:
Address the gaps between state funding and the required services for a growing population of infants and toddlers who enroll in ECI. Support efforts to maximize and streamline funding for ECI in Texas by working collaboratively with other state agencies, ECI programs, and lawmakers. Support efforts to increase efficiencies within ECI by addressing continuing eligibility, engaging in state-specific research on ECI’s long-term impact, and ensuring families are fully educated about available services, including Medicaid waiver interest lists.
How much will the bill cost?
In 2019, the Legislative Budget Board found that, in a bill identical to HB 908, the bill would not increase the state’s budget in a significant way. It is assumed that the provisions of the bill relating to health benefit plan coverage for ECI services could be absorbed using existing resources.
Is there a Senate companion to the bill?
No identical bill has been filed in the Senate at this time.
- HB 843 by Rep. Ray Lopez, relating to health benefit plan coverage for ECI intervention services, is identical to HB 908.
For the latest information about where HB 908 is in the process, follow the bill on the Texas Legislature Online. To receive future legislative updates from TCDD, subscribe to TCDD eNews or follow us on Twitter.