Texas 2009 - 81st Regular

Texas House Bill HB1418 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R4580 KCR-D
2	2	By: Rose H.B. No. 1418
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for the diagnosis and
8	8	treatment of eating disorders.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1375 to read as follows:
12	12	CHAPTER 1375. DIAGNOSIS AND TREATMENT OF EATING DISORDERS
13	13	Sec. 1375.001. DEFINITION. In this subchapter, "eating
14	14	disorder" means anorexia nervosa, bulimia nervosa, or an eating
15	15	disorder not otherwise specified, as those terms are defined by the
16	16	Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
17	17	Sec. 1375.002. APPLICABILITY OF CHAPTER. (a) Except as
18	18	provided by this section and notwithstanding any other law, this
19	19	chapter applies only to a health benefit plan, including a small
20	20	employer health benefit plan written under Chapter 1501 or coverage
21	21	provided by a health group cooperative under Subchapter B of that
22	22	chapter, that provides benefits for medical or surgical expenses
23	23	incurred as a result of a health condition, accident, or sickness,
24	24	including an individual, group, blanket, or franchise insurance
25	25	policy or insurance agreement, a group hospital service contract,
26	26	or an individual or group evidence of coverage or similar coverage
27	27	document that is offered by:
28	28	(1) an insurance company;
29	29	(2) a group hospital service corporation operating
30	30	under Chapter 842;
31	31	(3) a fraternal benefit society operating under
32	32	Chapter 885;
33	33	(4) a stipulated premium company operating under
34	34	Chapter 884;
35	35	(5) a reciprocal exchange operating under Chapter 942;
36	36	(6) a Lloyd's plan operating under Chapter 941;
37	37	(7) a health maintenance organization operating under
38	38	Chapter 843;
39	39	(8) a multiple employer welfare arrangement that holds
40	40	a certificate of authority under Chapter 846; or
41	41	(9) an approved nonprofit health corporation that
42	42	holds a certificate of authority under Chapter 844.
43	43	(b) Notwithstanding Section 172.014, Local Government Code,
44	44	or any other law, this chapter applies to health and accident
45	45	coverage provided by a risk pool created under Chapter 172, Local
46	46	Government Code.
47	47	(c) Notwithstanding any provision in Chapter 1551, 1575,
48	48	1579, or 1601 or any other law, this chapter applies to:
49	49	(1) a basic coverage plan under Chapter 1551;
50	50	(2) a basic plan under Chapter 1575;
51	51	(3) a primary care coverage plan under Chapter 1579;
52	52	and
53	53	(4) basic coverage under Chapter 1601.
54	54	(d) Notwithstanding any other law, a standard health
55	55	benefit plan provided under Chapter 1507 must provide the coverage
56	56	required by this chapter.
57	57	Sec. 1375.003. REQUIRED COVERAGE FOR EATING DISORDERS. (a)
58	58	A health benefit plan must provide coverage for the diagnosis of
59	59	eating disorders.
60	60	(b) A health benefit plan, based on medical necessity:
61	61	(1) must provide coverage for not less than the
62	62	following treatments of eating disorders in each calendar year:
63	63	(A) 60 days of inpatient treatment; and
64	64	(B) 60 visits for outpatient treatment,
65	65	including group and individual outpatient treatment;
66	66	(2) may not include a lifetime limitation on the
67	67	number of days of inpatient treatment or the number of visits for
68	68	outpatient treatment covered under the plan; and
69	69	(3) must include the same amount limitations,
70	70	deductibles, copayments, and coinsurance factors for eating
71	71	disorders as the plan includes for physical illness not related to
72	72	an eating disorder and, if applicable, for serious mental illness.
73	73	(c) A health benefit plan issuer:
74	74	(1) may not treat an outpatient visit for medication
75	75	or weight management as an outpatient visit required to be covered
76	76	under Subsection (b)(1)(B); and
77	77	(2) must provide coverage for an outpatient visit
78	78	described by Subsection (b)(1)(B) under the same terms as the
79	79	coverage the issuer provides for an outpatient visit for the
80	80	treatment of physical illness not related to an eating disorder
81	81	and, if applicable, for serious mental illness.
82	82	Sec. 1375.004. ACCESS TO PROVIDERS AND FACILITIES. (a)
83	83	Notwithstanding any other law, Subchapter B, Chapter 1451, applies
84	84	to a health benefit plan issuer with reference to coverage for the
85	85	diagnosis and treatment of eating disorders.
86	86	(b) A health benefit plan issuer:
87	87	(1) may not exclude or limit coverage for diagnosis or
88	88	treatment of an eating disorder based on the type of facility in
89	89	which the diagnosis or treatment occurs; and
90	90	(2) must allow an insured to receive diagnosis or
91	91	treatment of an eating disorder at an outpatient, inpatient, or
92	92	residential facility.
93	93	SECTION 2. Chapter 1375, Insurance Code, as added by this
94	94	Act, applies only to a health benefit plan that is delivered,
95	95	issued for delivery, or renewed on or after January 1, 2010. A
96	96	health benefit plan that is delivered, issued for delivery, or
97	97	renewed before January 1, 2010, is covered by the law in effect at
98	98	the time the plan was delivered, issued for delivery, or renewed,
99	99	and that law is continued in effect for that purpose.
100	100	SECTION 3. This Act takes effect September 1, 2009.