Texas 2017 - 85th Regular

Texas House Bill HB3891 Compare Versions

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

Old	New	Differences
1	1	By: Coleman H.B. No. 3891
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to coverage for eating disorders under certain health
7	7	benefit plans.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 1355.001, Insurance Code, is amended by
10	10	adding Subdivisions (5) to read as follows:
11	11	(5) "Eating disorder" means:
12	12	(A) any eating disorder described by the
13	13	Diagnostic and Statistical Manual of Mental Disorders, fifth
14	14	edition, or a later edition adopted by the commissioner by rule,
15	15	including:
16	16	(i) anorexia nervosa;
17	17	(ii) bulimia nervosa;
18	18	(iii) binge eating disorder;
19	19	(iv) rumination disorder;
20	20	(v) avoidant/restrictive food intake
21	21	disorder; or
22	22	(vi) any eating disorder not otherwise
23	23	specified; or
24	24	(B) any eating disorder contained in a subsequent
25	25	edition of the Diagnostic and Statistical Manual of Mental
26	26	Disorders published by the American Psychiatric Association and
27	27	adopted by the commissioner by rule.
28	28	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
29	29	amended by adding Section 1355.008 to read as follows:
30	30	Sec. 1355.008. REQUIRED COVERAGE FOR EATING DISORDERS. (a)
31	31	A health benefit plan must provide coverage, based on medical
32	32	necessity, for the diagnosis and treatment of an eating disorder.
33	33	(b) Coverage required under Subsection (a) is limited to a
34	34	service or medication, to the extent the service or medication is
35	35	covered by the health benefit plan, ordered by a licensed
36	36	physician, psychiatrist, psychologist, or therapist within the
37	37	scope of the practitioner's license and in accordance with a
38	38	treatment plan.
39	39	(c) On request from the health benefit plan issuer, an
40	40	eating disorder treatment plan must include all elements necessary
41	41	for the issuer to pay a claim under the health benefit plan, which
42	42	may include a diagnosis, goals, and proposed treatment by type,
43	43	frequency, and duration.
44	44	(d) Coverage required under Subsection (a) is not subject to
45	45	a limit on the number of days of medically necessary treatment
46	46	except as provided by the treatment plan.
47	47	(e) A health benefit plan issuer may conduct a utilization
48	48	review of an eating disorder treatment plan not more than once each
49	49	six months unless the physician, psychiatrist, psychologist, or
50	50	therapist treating the enrollee under the treatment plan agrees
51	51	that a more frequent review is necessary. An agreement to conduct
52	52	more frequent review under this subsection applies only to the
53	53	enrollee who is the subject of the agreement.
54	54	(f) A health benefit plan issuer shall pay any costs of
55	55	conducting a utilization review of coverage required under
56	56	Subsection (a) or obtaining a treatment plan.
57	57	(g) In conducting a utilization review of treatment for an
58	58	eating disorder, including review of medical necessity or the
59	59	treatment plan, a utilization review agent shall consider:
60	60	(1) the overall medical and mental health needs of the
61	61	individual with the eating disorder;
62	62	(2) factors in addition to weight; and
63	63	(3) the most recent Practice Guideline for the
64	64	Treatment of Patients with Eating Disorders adopted by the American
65	65	Psychiatric Association.
66	66	SECTION 3. The changes in law made by this Act apply only to
67	67	a health benefit plan that is delivered, issued for delivery, or
68	68	renewed on or after January 1, 2018. A health benefit plan that is
69	69	delivered, issued for delivery, or renewed before January 1, 2018,
70	70	is governed by the law as it existed immediately before the
71	71	effective date of this Act, and that law is continued in effect for
72	72	that purpose.
73	73	SECTION 4. This Act takes effect September 1, 2017.