81R3818 TJS-D
By: Coleman H.B. No. 2976
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for certain serious mental
illnesses and mental disorders.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.001, Insurance Code, is amended by
amending Subdivision (1) and adding Subdivision (5) to read as
follows:
(1) "Serious mental illness" means [the following]
psychiatric illnesses as defined by the American Psychiatric
Association in the Diagnostic and Statistical Manual (DSM), fourth
edition, or a later edition of that manual that the commissioner
adopts by rule. The term includes:
(A) bipolar disorders (hypomanic, manic,
depressive, and mixed);
(B) depression in childhood and adolescence;
(C) major depressive disorders (single episode
or recurrent);
(D) obsessive-compulsive disorders;
(E) paranoid and other psychotic disorders;
(F) schizo-affective disorders (bipolar or
depressive); and
(G) schizophrenia.
(5) "Mental disorder" means a disorder defined by the
American Psychiatric Association in the Diagnostic and Statistical
Manual (DSM), fourth edition, or a later edition of that manual that
the commissioner adopts by rule. The term does not include:
(A) a condition classified by the manual as a
"V-code" disorder;
(B) mental retardation;
(C) a learning disorder;
(D) a motor skill disorder; or
(E) a communication disorder.
SECTION 2. Subchapter F, Chapter 1501, Insurance Code, is
amended by adding Section 1501.253 to read as follows:
Sec. 1501.253. MENTAL HEALTH BENEFITS. (a) In this
section:
(1) "Mental disorder" has the meaning assigned by
Section 1355.001.
(2) "Serious mental illness" has the meaning assigned
by Section 1355.001.
(b) Notwithstanding Chapter 1507, a small employer health
benefit plan issuer shall offer coverage under the standard health
benefit plan offered under Section 1501.252, based on medical
necessity, for treatment of a serious mental illness or a mental
disorder that is not classified as a serious mental illness that is
equal to the coverage the plan includes for physical illness. The
issuer is not required to provide the coverage required under this
subsection if the employer rejects the coverage.
SECTION 3. Subchapter M, Chapter 1501, Insurance Code, is
amended by adding Section 1501.6025 to read as follows:
Sec. 1501.6025. MENTAL HEALTH BENEFITS. (a) In this
section:
(1) "Mental disorder" has the meaning assigned by
Section 1355.001.
(2) "Serious mental illness" has the meaning assigned
by Section 1355.001.
(b) A large employer health benefit plan issuer shall offer
coverage, based on medical necessity, for treatment of a mental
disorder that is not classified as a serious mental illness that is
equal to the coverage the plan includes for physical illness. The
issuer is not required to provide the coverage required under this
subsection if the employer rejects the coverage.
SECTION 4. The change in law made by this Act applies only
to a small employer health benefit plan or large employer 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 5. This Act takes effect September 1, 2009.