Texas 2009 - 81st Regular

Texas House Bill HB2969 Compare Versions

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

Old	New	Differences
1	1	81R10273 PB-D
2	2	By: Coleman H.B. No. 2969
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for an enrollee with
8	8	certain mental disorders.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. AMENDMENTS TO SUBCHAPTER A, CHAPTER 1355,
11	11	INSURANCE CODE
12	12	SECTION 1.01. Subchapter A, Chapter 1355, Insurance Code,
13	13	is amended to read as follows:
14	14	SUBCHAPTER A. [GROUP] HEALTH BENEFIT PLAN COVERAGE FOR
15	15	CERTAIN [SERIOUS] MENTAL [ILLNESSES AND OTHER] DISORDERS
16	16	Sec. 1355.001. DEFINITIONS. In this subchapter:
17	17	(1) "Mental disorder" ["Serious mental illness"]
18	18	means a disorder [the following psychiatric illnesses] as defined
19	19	by the American Psychiatric Association in the Diagnostic and
20	20	Statistical Manual of Mental Disorders, fourth edition, or in a
21	21	subsequent edition of that manual that the commissioner adopts to
22	22	take the place of the fourth edition or any subsequent edition for
23	23	the purposes of this subdivision, that results in an impairment of a
24	24	person's functioning in the person's community, employment, family,
25	25	school, or social group [(DSM):
26	26	[(A) bipolar disorders (hypomanic, manic,
27	27	depressive, and mixed);
28	28	[(B) depression in childhood and adolescence;
29	29	[(C) major depressive disorders (single episode
30	30	or recurrent);
31	31	[(D) obsessive-compulsive disorders;
32	32	[(E) paranoid and other psychotic disorders;
33	33	[(F) schizo-affective disorders (bipolar or
34	34	depressive); and
35	35	[(G) schizophrenia].
36	36	(2) ["Small employer" has the meaning assigned by
37	37	Section 1501.002.
38	38	[(3)] "Autism spectrum disorder" means a
39	39	neurobiological disorder that includes autism, Asperger's
40	40	syndrome, or Pervasive Developmental Disorder--Not Otherwise
41	41	Specified.
42	42	[(4) "Neurobiological disorder" means an illness of
43	43	the nervous system caused by genetic, metabolic, or other
44	44	biological factors.]
45	45	Sec. 1355.002. APPLICABILITY OF SUBCHAPTER. (a) This
46	46	subchapter applies only to a [group] health benefit plan that
47	47	provides benefits for medical or surgical expenses incurred as a
48	48	result of a health condition, accident, or sickness, including an
49	49	individual, [:
50	50	[(1) a] group, blanket, or franchise insurance policy
51	51	or [, group] insurance agreement, a group hospital service
52	52	contract, an individual or group evidence of coverage, or a similar
53	53	coverage document, that is offered by:
54	54	(1) [(A)] an insurance company;
55	55	(2) [(B)] a group hospital service corporation
56	56	operating under Chapter 842;
57	57	(3) [(C)] a fraternal benefit society operating under
58	58	Chapter 885;
59	59	(4) [(D)] a stipulated premium company operating
60	60	under Chapter 884; [or]
61	61	(5) [(E)] a health maintenance organization operating
62	62	under Chapter 843;
63	63	(6) a reciprocal exchange operating under Chapter 942;
64	64	(7) a Lloyd's plan operating under Chapter 941;
65	65	(8) an approved nonprofit health corporation that
66	66	holds a certificate of authority under Chapter 844; or [and]
67	67	(9) [(2) to the extent permitted by the Employee
68	68	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
69	69	seq.), a plan offered under:
70	70	[(A)] a multiple employer welfare arrangement
71	71	that holds a certificate of authority under Chapter 846 [as defined
72	72	by Section 3 of that Act; or
73	73	[(B) another analogous benefit arrangement].
74	74	(b) This subchapter applies to a small employer health
75	75	benefit plan written under Chapter 1501.
76	76	Sec. 1355.003. EXCEPTION. [(a)] This subchapter does not
77	77	apply to [coverage under]:
78	78	(1) a plan that provides coverage:
79	79	(A) only for benefits for a specified disease or
80	80	for another limited benefit, other than a plan that provides
81	81	benefits for mental health or similar services;
82	82	(B) only for accidental death or dismemberment;
83	83	(C) for wages or payments in lieu of wages for a
84	84	period during which an employee is absent from work because of
85	85	sickness or injury;
86	86	(D) as a supplement to a liability insurance
87	87	policy;
88	88	(E) only for dental or vision care;
89	89	(F) only for hospital expenses; or
90	90	(G) only for indemnity for hospital confinement;
91	91	(2) a Medicare supplemental policy as defined by
92	92	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
93	93	(3) a workers' compensation insurance policy;
94	94	(4) medical payment insurance coverage provided under
95	95	an automobile insurance policy;
96	96	(5) a credit insurance policy; or
97	97	(6) a long-term care insurance policy, including a
98	98	nursing home fixed indemnity policy, unless the commissioner
99	99	determines that the policy provides benefit coverage so
100	100	comprehensive that the policy is a health benefit plan as described
101	101	by Section 1355.002 [a blanket accident and health insurance
102	102	policy, as described by Chapter 1251;
103	103	[(2) a short-term travel policy;
104	104	[(3) an accident-only policy;
105	105	[(4) a limited or specified-disease policy that does
106	106	not provide benefits for mental health care or similar services;
107	107	[(5) except as provided by Subsection (b), a plan
108	108	offered under Chapter 1551 or Chapter 1601;
109	109	[(6) a plan offered in accordance with Section
110	110	1355.151; or
111	111	[(7) a Medicare supplement benefit plan, as defined by
112	112	Section 1652.002.
113	113	[(b) For the purposes of a plan described by Subsection
114	114	(a)(5), "serious mental illness" has the meaning assigned by
115	115	Section 1355.001].
116	116	Sec. 1355.004. REQUIRED COVERAGE [FOR SERIOUS MENTAL
117	117	ILLNESS]. [(a)] A group health benefit plan[:
118	118	[(1)] must provide coverage for the diagnosis and
119	119	treatment of a mental disorder under the same terms and conditions
120	120	as coverage provided for the diagnosis and treatment of physical
121	121	illness[, based on medical necessity, for not less than the
122	122	following treatments of serious mental illness in each calendar
123	123	year:
124	124	[(A) 45 days of inpatient treatment; and
125	125	[(B) 60 visits for outpatient treatment,
126	126	including group and individual outpatient treatment;
127	127	[(2) may not include a lifetime limitation on the
128	128	number of days of inpatient treatment or the number of visits for
129	129	outpatient treatment covered under the plan; and
130	130	[(3) must include the same amount limitations,
131	131	deductibles, copayments, and coinsurance factors for serious
132	132	mental illness as the plan includes for physical illness].
133	133	[(b) A group health benefit plan issuer:
134	134	[(1) may not count an outpatient visit for medication
135	135	management against the number of outpatient visits required to be
136	136	covered under Subsection (a)(1)(B); and
137	137	[(2) must provide coverage for an outpatient visit
138	138	described by Subsection (a)(1)(B) under the same terms as the
139	139	coverage the issuer provides for an outpatient visit for the
140	140	treatment of physical illness.]
141	141	Sec. 1355.005. COVERAGE OF INPATIENT STAYS AND OUTPATIENT
142	142	VISITS. A health benefit plan must cover inpatient stays and
143	143	outpatient visits under this subchapter under the same terms and
144	144	conditions as the plan covers inpatient stays and outpatient visits
145	145	for treatment of a physical illness. [MANAGED CARE PLAN
146	146	AUTHORIZED. A group health benefit plan issuer may provide or
147	147	offer coverage required by Section 1355.004 through a managed care
148	148	plan.]
149	149	Sec. 1355.006. AMOUNT LIMITS; DEDUCTIBLES; COPAYMENTS;
150	150	COINSURANCE. Coverage provided under this subchapter must be
151	151	subject to the same amount limits, deductibles, copayments, and
152	152	coinsurance factors as coverage for physical illness. [COVERAGE
153	153	FOR CERTAIN CONDITIONS RELATED TO CONTROLLED SUBSTANCE OR MARIHUANA
154	154	NOT REQUIRED. (a) In this section, "controlled substance" and
155	155	"marihuana" have the meanings assigned by Section 481.002, Health
156	156	and Safety Code.
157	157	[(b) This subchapter does not require a group health benefit
158	158	plan to provide coverage for the treatment of:
159	159	[(1) addiction to a controlled substance or marihuana
160	160	that is used in violation of law; or
161	161	[(2) mental illness that results from the use of a
162	162	controlled substance or marihuana in violation of law.]
163	163	Sec. 1355.007. RULES. The commissioner shall adopt rules
164	164	as necessary to implement this subchapter. [SMALL EMPLOYER
165	165	COVERAGE. An issuer of a group health benefit plan to a small
166	166	employer must offer the coverage described by Section 1355.004 to
167	167	the employer but is not required to provide the coverage if the
168	168	employer rejects the coverage.]
169	169	ARTICLE 2. CONFORMING AMENDMENTS
170	170	SECTION 2.01. Section 1355.151, Insurance Code, is amended
171	171	to read as follows:
172	172	Sec. 1355.151. PROHIBITION ON EXCLUSION OR LIMITATION OF
173	173	CERTAIN COVERAGES. (a) In this section, "mental disorder"
174	174	["serious mental illness"] has the meaning assigned by Section
175	175	1355.001.
176	176	(b) A political subdivision that provides group health
177	177	insurance coverage, health maintenance organization coverage, or
178	178	self-insured health care coverage to the political subdivision's
179	179	officers or employees may not contract for or provide coverage that
180	180	is less extensive for a mental disorder [serious mental illness]
181	181	than the coverage provided for any other physical illness.
182	182	SECTION 2.02. Section 1507.003(b), Insurance Code, is
183	183	amended to read as follows:
184	184	(b) For purposes of this subchapter, "state-mandated health
185	185	benefits" does not include benefits that are mandated by federal
186	186	law or standard provisions or rights required under this code or
187	187	other laws of this state to be provided in an individual, blanket,
188	188	or group policy for accident and health insurance that are
189	189	unrelated to a specific health illness, injury, or condition of an
190	190	insured, including provisions related to:
191	191	(1) continuation of coverage under:
192	192	(A) Subchapters F and G, Chapter 1251;
193	193	(B) Section 1201.059; and
194	194	(C) Subchapter B, Chapter 1253;
195	195	(2) termination of coverage under Sections 1202.051
196	196	and 1501.108;
197	197	(3) preexisting conditions under Subchapter D,
198	198	Chapter 1201, and Sections 1501.102-1501.105;
199	199	(4) coverage of children, including newborn or adopted
200	200	children, under:
201	201	(A) Subchapter D, Chapter 1251;
202	202	(B) Sections 1201.053, 1201.061,
203	203	1201.063-1201.065, and Subchapter A, Chapter 1367;
204	204	(C) Chapter 1504;
205	205	(D) Chapter 1503;
206	206	(E) Section 1501.157;
207	207	(F) Section 1501.158; and
208	208	(G) Sections 1501.607-1501.609;
209	209	(5) services of practitioners under:
210	210	(A) Subchapters A, B, and C, Chapter 1451; or
211	211	(B) Section 1301.052;
212	212	(6) supplies and services associated with the
213	213	treatment of diabetes under Subchapter B, Chapter 1358;
214	214	(7) coverage for a mental disorder [serious mental
215	215	illness] under Subchapter A, Chapter 1355;
216	216	(8) coverage for childhood immunizations and hearing
217	217	screening as required by Subchapters B and C, Chapter 1367, other
218	218	than Section 1367.053(c) and Chapter 1353;
219	219	(9) coverage for reconstructive surgery for certain
220	220	craniofacial abnormalities of children as required by Subchapter D,
221	221	Chapter 1367;
222	222	(10) coverage for the dietary treatment of
223	223	phenylketonuria as required by Chapter 1359;
224	224	(11) coverage for referral to a non-network physician
225	225	or provider when medically necessary covered services are not
226	226	available through network physicians or providers, as required by
227	227	Section 1271.055; and
228	228	(12) coverage for cancer screenings under:
229	229	(A) Chapter 1356;
230	230	(B) Chapter 1362;
231	231	(C) Chapter 1363; and
232	232	(D) Chapter 1370.
233	233	SECTION 2.03. Section 1507.053(b), Insurance Code, is
234	234	amended to read as follows:
235	235	(b) For purposes of this subchapter, "state-mandated health
236	236	benefits" does not include coverage that is mandated by federal law
237	237	or standard provisions or rights required under this code or other
238	238	laws of this state to be provided in an evidence of coverage that
239	239	are unrelated to a specific health illness, injury, or condition of
240	240	an enrollee, including provisions related to:
241	241	(1) continuation of coverage under Subchapter G,
242	242	Chapter 1251;
243	243	(2) termination of coverage under Sections 1202.051
244	244	and 1501.108;
245	245	(3) preexisting conditions under Subchapter D,
246	246	Chapter 1201, and Sections 1501.102-1501.105;
247	247	(4) coverage of children, including newborn or adopted
248	248	children, under:
249	249	(A) Chapter 1504;
250	250	(B) Chapter 1503;
251	251	(C) Section 1501.157;
252	252	(D) Section 1501.158; and
253	253	(E) Sections 1501.607-1501.609;
254	254	(5) services of providers under Section 843.304;
255	255	(6) coverage for a mental disorder [serious mental
256	256	health illness] under Subchapter A, Chapter 1355; and
257	257	(7) coverage for cancer screenings under:
258	258	(A) Chapter 1356;
259	259	(B) Chapter 1362;
260	260	(C) Chapter 1363; and
261	261	(D) Chapter 1370.
262	262	SECTION 2.04. Section 1551.003, Insurance Code, is amended
263	263	by adding Subdivision (10-a) to read as follows:
264	264	(10-a) "Mental disorder" has the meaning assigned by
265	265	Section 1355.001.
266	266	SECTION 2.05. Section 1551.205, Insurance Code, is amended
267	267	to read as follows:
268	268	Sec. 1551.205. LIMITATIONS. The board of trustees may not
269	269	contract for or provide a coverage plan that:
270	270	(1) excludes or limits coverage or services for
271	271	acquired immune deficiency syndrome, as defined by the Centers for
272	272	Disease Control and Prevention of the United States Public Health
273	273	Service, or human immunodeficiency virus infection;
274	274	(2) provides coverage for a mental disorder [serious
275	275	mental illness] that is less extensive than the coverage provided
276	276	for any physical illness; or
277	277	(3) may provide coverage for prescription drugs to
278	278	assist in stopping smoking at a lower benefit level than is provided
279	279	for other prescription drugs.
280	280	SECTION 2.06. Section 1601.109, Insurance Code, is amended
281	281	to read as follows:
282	282	Sec. 1601.109. COVERAGE FOR AIDS, HIV, OR [SERIOUS] MENTAL
283	283	DISORDER [ILLNESS]. (a) In this section, "mental disorder"
284	284	["serious mental illness"] has the meaning assigned by Section
285	285	1355.001.
286	286	(b) A system may not contract for or provide for group
287	287	insurance or HMO coverage or provide self-insured coverage, that:
288	288	(1) excludes or limits coverage or services for
289	289	acquired immune deficiency syndrome, as defined by the Centers for
290	290	Disease Control and Prevention of the United States Public Health
291	291	Service, or human immunodeficiency virus infection; or
292	292	(2) provides coverage for a mental disorder [serious
293	293	mental illness] that is less extensive than the coverage provided
294	294	for any other physical illness.
295	295	SECTION 2.07. Section 1551.003(12), Insurance Code, is
296	296	repealed.
297	297	ARTICLE 3. TRANSITION; EFFECTIVE DATE
298	298	SECTION 3.01. The change in law made by this Act applies
299	299	only to a health benefit plan delivered, issued for delivery, or
300	300	renewed on or after January 1, 2010. A health benefit plan
301	301	delivered, issued for delivery, or renewed before January 1, 2010,
302	302	is governed by the law as it existed immediately before the
303	303	effective date of this Act, and that law is continued in effect for
304	304	that purpose.
305	305	SECTION 3.02. This Act takes effect September 1, 2009.