By: Coleman H.B. No. 3891
A BILL TO BE ENTITLED
AN ACT
relating to coverage for eating disorders under certain health
benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.001, Insurance Code, is amended by
adding Subdivisions (5) to read as follows:
(5) "Eating disorder" means:
(A) any eating disorder described by the
Diagnostic and Statistical Manual of Mental Disorders, fifth
edition, or a later edition adopted by the commissioner by rule,
including:
(i) anorexia nervosa;
(ii) bulimia nervosa;
(iii) binge eating disorder;
(iv) rumination disorder;
(v) avoidant/restrictive food intake
disorder; or
(vi) any eating disorder not otherwise
specified; or
(B) any eating disorder contained in a subsequent
edition of the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association and
adopted by the commissioner by rule.
SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
amended by adding Section 1355.008 to read as follows:
Sec. 1355.008. REQUIRED COVERAGE FOR EATING DISORDERS. (a)
A health benefit plan must provide coverage, based on medical
necessity, for the diagnosis and treatment of an eating disorder.
(b) Coverage required under Subsection (a) is limited to a
service or medication, to the extent the service or medication is
covered by the health benefit plan, ordered by a licensed
physician, psychiatrist, psychologist, or therapist within the
scope of the practitioner's license and in accordance with a
treatment plan.
(c) On request from the health benefit plan issuer, an
eating disorder treatment plan must include all elements necessary
for the issuer to pay a claim under the health benefit plan, which
may include a diagnosis, goals, and proposed treatment by type,
frequency, and duration.
(d) Coverage required under Subsection (a) is not subject to
a limit on the number of days of medically necessary treatment
except as provided by the treatment plan.
(e) A health benefit plan issuer may conduct a utilization
review of an eating disorder treatment plan not more than once each
six months unless the physician, psychiatrist, psychologist, or
therapist treating the enrollee under the treatment plan agrees
that a more frequent review is necessary. An agreement to conduct
more frequent review under this subsection applies only to the
enrollee who is the subject of the agreement.
(f) A health benefit plan issuer shall pay any costs of
conducting a utilization review of coverage required under
Subsection (a) or obtaining a treatment plan.
(g) In conducting a utilization review of treatment for an
eating disorder, including review of medical necessity or the
treatment plan, a utilization review agent shall consider:
(1) the overall medical and mental health needs of the
individual with the eating disorder;
(2) factors in addition to weight; and
(3) the most recent Practice Guideline for the
Treatment of Patients with Eating Disorders adopted by the American
Psychiatric Association.
SECTION 3. The changes in law made by this Act apply only to
a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2018. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2018,
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 4. This Act takes effect September 1, 2017.