| 1 | 1 | | 81R3818 TJS-D |
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| 2 | 2 | | By: Coleman H.B. No. 2976 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to health benefit plan coverage for certain serious mental |
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| 8 | 8 | | illnesses and mental disorders. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 1355.001, Insurance Code, is amended by |
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| 11 | 11 | | amending Subdivision (1) and adding Subdivision (5) to read as |
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| 12 | 12 | | follows: |
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| 13 | 13 | | (1) "Serious mental illness" means [the following] |
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| 14 | 14 | | psychiatric illnesses as defined by the American Psychiatric |
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| 15 | 15 | | Association in the Diagnostic and Statistical Manual (DSM), fourth |
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| 16 | 16 | | edition, or a later edition of that manual that the commissioner |
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| 17 | 17 | | adopts by rule. The term includes: |
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| 18 | 18 | | (A) bipolar disorders (hypomanic, manic, |
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| 19 | 19 | | depressive, and mixed); |
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| 20 | 20 | | (B) depression in childhood and adolescence; |
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| 21 | 21 | | (C) major depressive disorders (single episode |
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| 22 | 22 | | or recurrent); |
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| 23 | 23 | | (D) obsessive-compulsive disorders; |
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| 24 | 24 | | (E) paranoid and other psychotic disorders; |
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| 25 | 25 | | (F) schizo-affective disorders (bipolar or |
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| 26 | 26 | | depressive); and |
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| 27 | 27 | | (G) schizophrenia. |
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| 28 | 28 | | (5) "Mental disorder" means a disorder defined by the |
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| 29 | 29 | | American Psychiatric Association in the Diagnostic and Statistical |
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| 30 | 30 | | Manual (DSM), fourth edition, or a later edition of that manual that |
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| 31 | 31 | | the commissioner adopts by rule. The term does not include: |
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| 32 | 32 | | (A) a condition classified by the manual as a |
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| 33 | 33 | | "V-code" disorder; |
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| 34 | 34 | | (B) mental retardation; |
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| 35 | 35 | | (C) a learning disorder; |
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| 36 | 36 | | (D) a motor skill disorder; or |
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| 37 | 37 | | (E) a communication disorder. |
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| 38 | 38 | | SECTION 2. Subchapter F, Chapter 1501, Insurance Code, is |
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| 39 | 39 | | amended by adding Section 1501.253 to read as follows: |
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| 40 | 40 | | Sec. 1501.253. MENTAL HEALTH BENEFITS. (a) In this |
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| 41 | 41 | | section: |
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| 42 | 42 | | (1) "Mental disorder" has the meaning assigned by |
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| 43 | 43 | | Section 1355.001. |
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| 44 | 44 | | (2) "Serious mental illness" has the meaning assigned |
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| 45 | 45 | | by Section 1355.001. |
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| 46 | 46 | | (b) Notwithstanding Chapter 1507, a small employer health |
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| 47 | 47 | | benefit plan issuer shall offer coverage under the standard health |
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| 48 | 48 | | benefit plan offered under Section 1501.252, based on medical |
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| 49 | 49 | | necessity, for treatment of a serious mental illness or a mental |
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| 50 | 50 | | disorder that is not classified as a serious mental illness that is |
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| 51 | 51 | | equal to the coverage the plan includes for physical illness. The |
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| 52 | 52 | | issuer is not required to provide the coverage required under this |
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| 53 | 53 | | subsection if the employer rejects the coverage. |
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| 54 | 54 | | SECTION 3. Subchapter M, Chapter 1501, Insurance Code, is |
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| 55 | 55 | | amended by adding Section 1501.6025 to read as follows: |
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| 56 | 56 | | Sec. 1501.6025. MENTAL HEALTH BENEFITS. (a) In this |
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| 57 | 57 | | section: |
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| 58 | 58 | | (1) "Mental disorder" has the meaning assigned by |
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| 59 | 59 | | Section 1355.001. |
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| 60 | 60 | | (2) "Serious mental illness" has the meaning assigned |
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| 61 | 61 | | by Section 1355.001. |
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| 62 | 62 | | (b) A large employer health benefit plan issuer shall offer |
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| 63 | 63 | | coverage, based on medical necessity, for treatment of a mental |
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| 64 | 64 | | disorder that is not classified as a serious mental illness that is |
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| 65 | 65 | | equal to the coverage the plan includes for physical illness. The |
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| 66 | 66 | | issuer is not required to provide the coverage required under this |
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| 67 | 67 | | subsection if the employer rejects the coverage. |
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| 68 | 68 | | SECTION 4. The change in law made by this Act applies only |
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| 69 | 69 | | to a small employer health benefit plan or large employer health |
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| 70 | 70 | | benefit plan that is delivered, issued for delivery, or renewed on |
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| 71 | 71 | | or after January 1, 2010. A health benefit plan that is delivered, |
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| 72 | 72 | | issued for delivery, or renewed before January 1, 2010, is covered |
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| 73 | 73 | | by the law in effect at the time the plan was delivered, issued for |
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| 74 | 74 | | delivery, or renewed, and that law is continued in effect for that |
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| 75 | 75 | | purpose. |
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| 76 | 76 | | SECTION 5. This Act takes effect September 1, 2009. |
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