85R8019 PMO-D
By: Menéndez S.B. No. 756
A BILL TO BE ENTITLED
AN ACT
relating to required coverage for obesity under group health
benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1372 to read as follows:
CHAPTER 1372. OBESITY
Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a group health benefit plan that provides benefits
for medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including a group insurance
policy, group insurance agreement, group hospital service
contract, or group evidence of coverage or similar coverage
document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(5) a stipulated premium company operating under
Chapter 884; or
(6) a fraternal benefit society operating under
Chapter 885.
(b) Notwithstanding any other law, this chapter applies to
group coverage provided through a small employer health benefit
plan subject to Chapter 1501, including group coverage provided
through a health group cooperative under Subchapter B of that
chapter.
Sec. 1372.002. CONDITIONAL EXCEPTION. This chapter does
not apply to a qualified health plan if a determination is made
under 45 C.F.R. Section 155.170 that:
(1) this chapter requires the plan to offer benefits
in addition to the essential health benefits required under 42
U.S.C. Section 18022(b); and
(2) this state is required to defray the cost of the
benefits mandated under this chapter.
Sec. 1372.003. REQUIRED COVERAGE FOR OBESITY. (a) A group
health benefit plan must provide coverage, based on medical
necessity, for the diagnosis and treatment of obesity.
(b) Coverage required under Subsection (a) is limited to a
service, including bariatric surgery and nutritional counseling
and therapy, or a medication, to the extent the group health benefit
plan provides pharmacy benefits, 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 group health benefit plan issuer, an
obesity treatment plan must include all elements necessary for the
issuer to pay a claim under the group health benefit plan, which may
include a diagnosis, goals, and proposed treatment by type,
frequency, and duration.
SECTION 2. Not later than November 1 of each even-numbered
year, the comptroller of public accounts shall prepare and submit
to the legislature a biennial report on the human and financial cost
of obesity in this state. This section expires December 1, 2020.
SECTION 3. The changes in law made by this Act apply only to
a group health benefit plan delivered, issued for delivery, or
renewed on or after January 1, 2018.
SECTION 4. This Act takes effect September 1, 2017.