Sec. 1271.156. BENEFITS FOR REHABILITATION SERVICES AND THERAPIES. (a) If benefits are provided for rehabilitation services and therapies under an evidence of coverage, the provision of a rehabilitation service or therapy that, in the opinion of a physician, is medically necessary may not be denied, limited, or terminated if the service or therapy meets or exceeds treatment goals for the enrollee.
(b) For an enrollee with a physical disability, treatment goals may include maintenance of functioning or prevention of or slowing of further deterioration.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges
Subchapter D. Certain Benefits Required
Section 1271.151. Provision of Basic Health Care Services
Section 1271.152. Standards for Basic Health Care Services
Section 1271.153. Periodic Health Evaluations
Section 1271.154. Well-Child Care From Birth
Section 1271.155. Emergency Care
Section 1271.156. Benefits for Rehabilitation Services and Therapies
Section 1271.157. Non-Network Facility-Based Providers
Section 1271.158. Non-Network Diagnostic Imaging Provider or Laboratory Service Provider