Texas 2017 - 85th Regular

Texas Senate Bill SB756 Compare Versions

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

Old	New	Differences
1	1	85R8019 PMO-D
2	2	By: Menéndez S.B. No. 756
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to required coverage for obesity under group health
8	8	benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1372 to read as follows:
12	12	CHAPTER 1372. OBESITY
13	13	Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter
14	14	applies only to a group health benefit plan that provides benefits
15	15	for medical or surgical expenses incurred as a result of a health
16	16	condition, accident, or sickness, including a group insurance
17	17	policy, group insurance agreement, group hospital service
18	18	contract, or group evidence of coverage or similar coverage
19	19	document that is offered by:
20	20	(1) an insurance company;
21	21	(2) a group hospital service corporation operating
22	22	under Chapter 842;
23	23	(3) a health maintenance organization operating under
24	24	Chapter 843;
25	25	(4) a multiple employer welfare arrangement that holds
26	26	a certificate of authority under Chapter 846;
27	27	(5) a stipulated premium company operating under
28	28	Chapter 884; or
29	29	(6) a fraternal benefit society operating under
30	30	Chapter 885.
31	31	(b) Notwithstanding any other law, this chapter applies to
32	32	group coverage provided through a small employer health benefit
33	33	plan subject to Chapter 1501, including group coverage provided
34	34	through a health group cooperative under Subchapter B of that
35	35	chapter.
36	36	Sec. 1372.002. CONDITIONAL EXCEPTION. This chapter does
37	37	not apply to a qualified health plan if a determination is made
38	38	under 45 C.F.R. Section 155.170 that:
39	39	(1) this chapter requires the plan to offer benefits
40	40	in addition to the essential health benefits required under 42
41	41	U.S.C. Section 18022(b); and
42	42	(2) this state is required to defray the cost of the
43	43	benefits mandated under this chapter.
44	44	Sec. 1372.003. REQUIRED COVERAGE FOR OBESITY. (a) A group
45	45	health benefit plan must provide coverage, based on medical
46	46	necessity, for the diagnosis and treatment of obesity.
47	47	(b) Coverage required under Subsection (a) is limited to a
48	48	service, including bariatric surgery and nutritional counseling
49	49	and therapy, or a medication, to the extent the group health benefit
50	50	plan provides pharmacy benefits, ordered by a licensed physician,
51	51	psychiatrist, psychologist, or therapist within the scope of the
52	52	practitioner's license and in accordance with a treatment plan.
53	53	(c) On request from the group health benefit plan issuer, an
54	54	obesity treatment plan must include all elements necessary for the
55	55	issuer to pay a claim under the group health benefit plan, which may
56	56	include a diagnosis, goals, and proposed treatment by type,
57	57	frequency, and duration.
58	58	SECTION 2. Not later than November 1 of each even-numbered
59	59	year, the comptroller of public accounts shall prepare and submit
60	60	to the legislature a biennial report on the human and financial cost
61	61	of obesity in this state. This section expires December 1, 2020.
62	62	SECTION 3. The changes in law made by this Act apply only to
63	63	a group health benefit plan delivered, issued for delivery, or
64	64	renewed on or after January 1, 2018.
65	65	SECTION 4. This Act takes effect September 1, 2017.