81R11786 BEF-D
By: Bolton H.B. No. 3460
A BILL TO BE ENTITLED
AN ACT
relating to group health benefit plan coverage for certain mental
illnesses and the amount of the franchise tax incentive for certain
small employers that provide health care benefits to employees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.003, Insurance Code, is amended to
read as follows:
Sec. 1355.003. EXCEPTION. [(a)] This subchapter does not
apply to coverage under:
(1) a blanket accident and health insurance policy, as
described by Chapter 1251;
(2) a short-term travel policy;
(3) an accident-only policy;
(4) a limited or specified-disease policy that does
not provide benefits for mental health care or similar services;
(5) [except as provided by Subsection (b), a plan
offered under Chapter 1551 or Chapter 1601;
[(6)] a plan offered in accordance with Section
1355.151; or
(6) [(7)] a Medicare supplement benefit plan, as
defined by Section 1652.002.
[(b) For the purposes of a plan described by Subsection
(a)(5), "serious mental illness" has the meaning assigned by
Section 1355.001.]
SECTION 2. Section 1355.004, Insurance Code, is amended to
read as follows:
Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL
ILLNESS; COVERAGE PARITY. (a) A group health benefit plan:
(1) must provide coverage, based on medical necessity,
for the diagnosis and treatment of a serious mental illness under
terms at least as favorable as those provided for the diagnosis and
treatment of medical and surgical conditions, and in no case [not]
less than the following treatments [of serious mental illness] in
each calendar year:
(A) 45 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 serious
mental illness as the plan includes for physical illness; and
(4) may not impose treatment limitations or financial
requirements on the provision of benefits under this subchapter for
a serious mental illness if identical limitations or requirements
are not imposed on coverage of benefits for other medical
conditions.
(b) A group health benefit plan issuer:
(1) may not count an outpatient visit for medication
management against the number of outpatient visits required to be
covered under Subsection (a)(1)(B); and
(2) must provide coverage for an outpatient visit
described by Subsection (a)(1)(B) under the same terms as the
coverage the issuer provides for an outpatient visit for the
treatment of physical illness.
SECTION 3. Section 171.1013(b-1), Tax Code, is amended to
read as follows:
(b-1) This subsection applies to a taxable entity that is a
small employer, as that term is defined by Section 1501.002,
Insurance Code, and that has not provided health care benefits to
any of its employees in the calendar year preceding the beginning
date of its reporting period. Subject to Section 171.1014, a
taxable entity to which this subsection applies that elects to
subtract compensation for the purpose of computing its taxable
margin under Section 171.101 may subtract health care benefits as
provided under Subsection (b) and may also subtract:
(1) for the first 12-month period on which margin is
based and in which the taxable entity provides health care benefits
to all of its employees, an additional amount equal to:
(A) 50 percent of the cost of health care
benefits that do not meet the requirements of Section 1355.004,
Insurance Code, provided to its employees for that period; or
(B) 75 percent of the cost of health care
benefits that meet the requirements of Section 1355.004, Insurance
Code, provided to its employees for that period; [and]
(2) for the second 12-month period on which margin is
based and in which the taxable entity provides health care benefits
to all of its employees, an additional amount equal to:
(A) 25 percent of the cost of health care
benefits that do not meet the requirements of Section 1355.004,
Insurance Code, provided to its employees for that period; or
(B) 50 percent of the cost of health care
benefits that meet the requirements of Section 1355.004, Insurance
Code, provided to its employees for that period; and
(3) for the third 12-month period on which margin is
based and in which the taxable entity provides health care benefits
to all of its employees, an additional amount equal to 25 percent of
the cost of health care benefits that meet the requirements of
Section 1355.004, Insurance Code, provided to its employees for
that period.
SECTION 4. The changes in law made by this Act by the
amendment of Sections 1355.003 and 1355.004, Insurance Code, apply
only to a group health benefit plan delivered, issued for delivery,
or renewed on or after January 1, 2010. A group health benefit plan
delivered, issued for delivery, or renewed before January 1, 2010,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 5. The change in law made by this Act by the
amendment of Section 171.1013(b-1), Tax Code, applies only to a
report originally due on or after the effective date of this Act.
SECTION 6. This Act takes effect January 1, 2010.