81R4451 TJS-D
By: Bolton H.B. No. 1121
A BILL TO BE ENTITLED
AN ACT
relating to group health benefit plan coverage for certain mental
illnesses.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.003, Insurance Code, is amended to
read as follows:
Sec. 1355.003. EXCEPTION. [(a)] This subchapter does not
apply to coverage under:
(1) a blanket accident and health insurance policy, as
described by Chapter 1251;
(2) a short-term travel policy;
(3) an accident-only policy;
(4) a limited or specified-disease policy that does
not provide benefits for mental health care or similar services;
(5) [except as provided by Subsection (b), a plan
offered under Chapter 1551 or Chapter 1601;
[(6)] a plan offered in accordance with Section
1355.151; or
(6) [(7)] a Medicare supplement benefit plan, as
defined by Section 1652.002.
[(b) For the purposes of a plan described by Subsection
(a)(5), "serious mental illness" has the meaning assigned by
Section 1355.001.]
SECTION 2. Section 1355.004, Insurance Code, is amended to
read as follows:
Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL
ILLNESS; COVERAGE PARITY. (a) A group health benefit plan:
(1) must provide coverage, based on medical necessity,
for the diagnosis and treatment of a serious mental illness under
terms at least as favorable as those provided for the diagnosis and
treatment of medical and surgical conditions, and in no case [not]
less than the following treatments [of serious mental illness] in
each calendar year:
(A) 45 days of inpatient treatment; and
(B) 60 visits for outpatient treatment,
including group and individual outpatient treatment;
(2) may not include a lifetime limitation on the
number of days of inpatient treatment or the number of visits for
outpatient treatment covered under the plan; [and]
(3) must include the same amount limitations,
deductibles, copayments, and coinsurance factors for serious
mental illness as the plan includes for physical illness; and
(4) may not impose treatment limitations or financial
requirements on the provision of benefits under this subchapter for
a serious mental illness if identical limitations or requirements
are not imposed on coverage of benefits for other medical
conditions.
(b) A group health benefit plan issuer:
(1) may not count an outpatient visit for medication
management against the number of outpatient visits required to be
covered under Subsection (a)(1)(B); and
(2) must provide coverage for an outpatient visit
described by Subsection (a)(1)(B) under the same terms as the
coverage the issuer provides for an outpatient visit for the
treatment of physical illness.
SECTION 3. The change in law made by this Act applies only
to a group health benefit plan delivered, issued for delivery, or
renewed on or after January 1, 2010. A group health benefit plan
delivered, issued for delivery, or renewed before January 1, 2010,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 4. This Act takes effect September 1, 2009.