Texas 2011 - 82nd Regular

Texas House Bill HB1192 Compare Versions

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Old	New	Differences
1	1	82R23118 PMO-F
2	2	By: Castro H.B. No. 1192
3	3	Substitute the following for H.B. No. 1192:
4	4	By: Eiland C.S.H.B. No. 1192
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the requirement and study of insurance coverage for
10	10	serious emotional disturbance of a child.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 1355.001, Insurance Code, is amended by
13	13	adding Subdivision (5) to read as follows:
14	14	(5) "Serious emotional disturbance of a child" means
15	15	an emotional or behavioral disorder or a neuropsychiatric condition
16	16	that causes a person's functioning to be impaired in thought,
17	17	perception, affect, or behavior and that:
18	18	(A) has been diagnosed, by a physician licensed
19	19	to practice medicine in this state, a psychologist licensed to
20	20	practice in this state, or a licensed professional counselor
21	21	licensed to practice in this state, in a person who is at least
22	22	three years of age and younger than 17 years of age; and
23	23	(B) meets at least one of the following criteria:
24	24	(i) the disorder substantially impairs the
25	25	person's ability in at least two of the following activities or
26	26	tasks:
27	27	(a) self-care;
28	28	(b) engaging in family relationships;
29	29	(c) functioning in school; or
30	30	(d) functioning in the community;
31	31	(ii) the disorder creates a risk that the
32	32	person will be removed from the person's home and placed in a more
33	33	restrictive environment, including in a facility or program
34	34	operated by the Department of Family and Protective Services or an
35	35	agency that is part of the juvenile justice system;
36	36	(iii) the disorder causes the person to:
37	37	(a) display psychotic features or
38	38	violent behavior; or
39	39	(b) pose a danger to the person's self
40	40	or others; or
41	41	(iv) the disorder results in the person
42	42	meeting state special education eligibility requirements for
43	43	serious emotional disturbance.
44	44	SECTION 2. The heading to Section 1355.004, Insurance Code,
45	45	is amended to read as follows:
46	46	Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL
47	47	DISTURBANCE OF A CHILD AND SERIOUS MENTAL ILLNESS.
48	48	SECTION 3. Section 1355.004, Insurance Code, is amended by
49	49	amending Subsection (a) and adding Subsections (c), (d), and (e) to
50	50	read as follows:
51	51	(a) A group health benefit plan:
52	52	(1) must provide coverage for serious emotional
53	53	disturbance of a child diagnosed as described by Section
54	54	1355.001(5) and coverage, based on medical necessity, for serious
55	55	mental illness for not less than the following treatments [of
56	56	serious mental illness] in each calendar year:
57	57	(A) 45 days of inpatient treatment; and
58	58	(B) 60 visits for outpatient treatment,
59	59	including group and individual outpatient treatment;
60	60	(2) may not include a lifetime limitation on the
61	61	number of days of inpatient treatment or the number of visits for
62	62	outpatient treatment covered under the plan; and
63	63	(3) must include the same amount limitations,
64	64	deductibles, copayments, and coinsurance factors for serious
65	65	emotional disturbance of a child and serious mental illness as the
66	66	plan includes for physical illness.
67	67	(c) The department shall conduct a study to determine and
68	68	evaluate the extent to which enrollees are making claims under
69	69	coverage for serious emotional disturbance of a child and the
70	70	impact, if any, the coverage for serious emotional disturbance of a
71	71	child and the claims have on the cost of the coverage for group
72	72	health benefit plans.
73	73	(d) Not later than August 1, 2012, the department shall
74	74	submit to the governor, the lieutenant governor, the speaker of the
75	75	house of representatives, and the appropriate standing committees
76	76	of the legislature a report regarding the results of the study
77	77	required by Subsection (c), together with any recommendations for
78	78	legislation.
79	79	(e) This subsection and Subsections (c) and (d) expire
80	80	September 1, 2013.
81	81	SECTION 4. Section 1355.054(a), Insurance Code, is amended
82	82	to read as follows:
83	83	(a) Benefits of coverage provided under this subchapter may
84	84	be used only in a situation in which:
85	85	(1) the covered individual has a serious mental
86	86	illness or serious emotional disturbance of a child that requires
87	87	confinement of the individual in a hospital unless treatment is
88	88	available through a residential treatment center for children and
89	89	adolescents or a crisis stabilization unit; and
90	90	(2) the covered individual's mental illness or
91	91	emotional disturbance:
92	92	(A) substantially impairs the individual's
93	93	thought, perception of reality, emotional process, or judgment; or
94	94	(B) as manifested by the individual's recent
95	95	disturbed behavior, grossly impairs the individual's behavior.
96	96	SECTION 5. The change in law made by this Act applies only
97	97	to a group health benefit plan that is delivered, issued for
98	98	delivery, or renewed on or after January 1, 2012. A group health
99	99	benefit plan that is delivered, issued for delivery, or renewed
100	100	before January 1, 2012, is governed by the law as it existed
101	101	immediately before the effective date of this Act, and that law is
102	102	continued in effect for that purpose.
103	103	SECTION 6. This Act takes effect September 1, 2011.