81R4580 KCR-D
By: Rose H.B. No. 1418
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for the diagnosis and
treatment of eating disorders.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1375 to read as follows:
CHAPTER 1375. DIAGNOSIS AND TREATMENT OF EATING DISORDERS
Sec. 1375.001. DEFINITION. In this subchapter, "eating
disorder" means anorexia nervosa, bulimia nervosa, or an eating
disorder not otherwise specified, as those terms are defined by the
Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
Sec. 1375.002. APPLICABILITY OF CHAPTER. (a) Except as
provided by this section and notwithstanding any other law, this
chapter applies only to a health benefit plan, including a small
employer health benefit plan written under Chapter 1501 or coverage
provided by a health group cooperative under Subchapter B of that
chapter, 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 offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a Lloyd's plan operating under Chapter 941;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) Notwithstanding Section 172.014, Local Government Code,
or any other law, this chapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(c) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(d) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this chapter.
Sec. 1375.003. REQUIRED COVERAGE FOR EATING DISORDERS. (a)
A health benefit plan must provide coverage for the diagnosis of
eating disorders.
(b) A health benefit plan, based on medical necessity:
(1) must provide coverage for not less than the
following treatments of eating disorders in each calendar year:
(A) 60 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 eating
disorders as the plan includes for physical illness not related to
an eating disorder and, if applicable, for serious mental illness.
(c) A health benefit plan issuer:
(1) may not treat an outpatient visit for medication
or weight management as an outpatient visit required to be covered
under Subsection (b)(1)(B); and
(2) must provide coverage for an outpatient visit
described by Subsection (b)(1)(B) under the same terms as the
coverage the issuer provides for an outpatient visit for the
treatment of physical illness not related to an eating disorder
and, if applicable, for serious mental illness.
Sec. 1375.004. ACCESS TO PROVIDERS AND FACILITIES. (a)
Notwithstanding any other law, Subchapter B, Chapter 1451, applies
to a health benefit plan issuer with reference to coverage for the
diagnosis and treatment of eating disorders.
(b) A health benefit plan issuer:
(1) may not exclude or limit coverage for diagnosis or
treatment of an eating disorder based on the type of facility in
which the diagnosis or treatment occurs; and
(2) must allow an insured to receive diagnosis or
treatment of an eating disorder at an outpatient, inpatient, or
residential facility.
SECTION 2. Chapter 1375, 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, 2010. A
health benefit plan that is delivered, issued for delivery, or
renewed before January 1, 2010, is covered by the law in effect at
the time the plan was delivered, issued for delivery, or renewed,
and that law is continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2009.