Texas 2017 - 85th 1st C.S.

Texas House Bill HB126 Compare Versions

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

Old	New	Differences
1	1	85S10492 PMO-F
2	2	By: Thompson of Harris H.B. No. 126
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the requirement and study of insurance coverage for
8	8	serious emotional disturbance of a child.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1355.001, Insurance Code, is amended by
11	11	adding Subdivision (5) to read as follows:
12	12	(5) "Serious emotional disturbance of a child" means
13	13	an emotional or behavioral disorder or a neuropsychiatric condition
14	14	that causes a person's functioning to be impaired in thought,
15	15	perception, affect, or behavior and that:
16	16	(A) has been diagnosed, by a physician licensed
17	17	to practice medicine in this state, a psychologist licensed to
18	18	practice in this state, or a licensed professional counselor
19	19	licensed to practice in this state, in a person who is at least
20	20	three years of age and younger than 18 years of age; and
21	21	(B) meets at least one of the following criteria:
22	22	(i) the disorder or condition substantially
23	23	impairs the person's ability in at least two of the following
24	24	activities or tasks:
25	25	(a) self-care;
26	26	(b) engaging in family relationships;
27	27	(c) functioning in school; or
28	28	(d) functioning in the community;
29	29	(ii) the disorder or condition creates a
30	30	risk that the person will be removed from the person's home and
31	31	placed in a more restrictive environment, including in a facility
32	32	or program operated by the Department of Family and Protective
33	33	Services or an agency that is part of the juvenile justice system;
34	34	(iii) the disorder or condition causes the
35	35	person to:
36	36	(a) display psychotic features or
37	37	violent behavior; or
38	38	(b) pose a danger to the person's self
39	39	or others; or
40	40	(iv) the disorder or condition results in
41	41	the person meeting state special education eligibility
42	42	requirements for emotional disturbance.
43	43	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
44	44	amended by adding Section 1355.0041 to read as follows:
45	45	Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL
46	46	DISTURBANCE OF A CHILD. (a) Notwithstanding Section 1355.002,
47	47	this section does not apply to:
48	48	(1) a basic plan under Chapter 1575; or
49	49	(2) a primary care coverage plan under Chapter 1579.
50	50	(b) A group health benefit plan:
51	51	(1) must provide coverage for serious emotional
52	52	disturbance of a child, based on medical necessity, for not less
53	53	than the following treatments in each calendar year:
54	54	(A) 45 days of inpatient treatment; and
55	55	(B) 60 visits for outpatient treatment,
56	56	including group and individual outpatient treatment;
57	57	(2) may not include a lifetime limitation on the
58	58	number of days of inpatient treatment or the number of visits for
59	59	outpatient treatment covered under the plan; and
60	60	(3) must include the same amount limitations,
61	61	deductibles, copayments, and coinsurance factors for serious
62	62	emotional disturbance of a child as the plan includes for physical
63	63	illness.
64	64	(c) A group health benefit plan issuer:
65	65	(1) may not count an outpatient visit for medication
66	66	management against the number of outpatient visits required to be
67	67	covered under Subsection (b)(1)(B); and
68	68	(2) must provide coverage for an outpatient visit
69	69	described by Subsection (b)(1)(B) under the same terms as the
70	70	coverage the issuer provides for an outpatient visit for the
71	71	treatment of physical illness.
72	72	(d) The department shall conduct a study to determine and
73	73	evaluate the extent to which enrollees make claims under coverage
74	74	for serious emotional disturbance of a child and the impact, if any,
75	75	the coverage for serious emotional disturbance of a child and the
76	76	claims have on the cost of the coverage for group health benefit
77	77	plans.
78	78	(e) Not later than August 1, 2018, the department shall
79	79	submit to the governor, the lieutenant governor, the speaker of the
80	80	house of representatives, and the appropriate standing committees
81	81	of the legislature a report regarding the results of the study
82	82	required by Subsection (d), together with any recommendations for
83	83	legislation.
84	84	(f) This subsection and Subsections (d) and (e) expire
85	85	September 1, 2019.
86	86	SECTION 3. Sections 1355.005 and 1355.007, Insurance Code,
87	87	are amended to read as follows:
88	88	Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A group
89	89	health benefit plan issuer may provide or offer coverage required
90	90	by Section 1355.004 or 1355.0041 through a managed care plan.
91	91	Sec. 1355.007. SMALL EMPLOYER COVERAGE. An issuer of a
92	92	group health benefit plan to a small employer must offer the
93	93	coverage described by Section 1355.004 or 1355.0041 to the employer
94	94	but is not required to provide the coverage if the employer rejects
95	95	the coverage.
96	96	SECTION 4. Section 1355.051, Insurance Code, is amended by
97	97	adding Subdivision (4) to read as follows:
98	98	(4) "Serious emotional disturbance of a child" has the
99	99	meaning assigned by Section 1355.001.
100	100	SECTION 5. Section 1355.053, Insurance Code, is amended to
101	101	read as follows:
102	102	Sec. 1355.053. REQUIRED COVERAGE FOR CERTAIN ILLNESSES,
103	103	[AND] DISORDERS, AND CONDITIONS. A group health benefit plan that
104	104	provides coverage for treatment of mental or emotional illness or
105	105	disorder or serious emotional disturbance of a child for a covered
106	106	individual when the individual is confined in a hospital must also
107	107	provide coverage for treatment in a residential treatment center
108	108	for children and adolescents or a crisis stabilization unit that is
109	109	at least as favorable as the coverage the plan provides for
110	110	treatment of mental or emotional illness or disorder or serious
111	111	emotional disturbance of a child in a hospital.
112	112	SECTION 6. Section 1355.054(a), Insurance Code, is amended
113	113	to read as follows:
114	114	(a) Benefits of coverage provided under this subchapter may
115	115	be used only in a situation in which:
116	116	(1) the covered individual has a serious mental
117	117	illness or serious emotional disturbance of a child that requires
118	118	confinement of the individual in a hospital unless treatment is
119	119	available through a residential treatment center for children and
120	120	adolescents or a crisis stabilization unit; and
121	121	(2) the covered individual's mental illness or
122	122	emotional disturbance:
123	123	(A) substantially impairs the individual's
124	124	thought, perception of reality, emotional process, or judgment; or
125	125	(B) as manifested by the individual's recent
126	126	disturbed behavior, grossly impairs the individual's behavior.
127	127	SECTION 7. The change in law made by this Act applies only
128	128	to a group health benefit plan that is delivered, issued for
129	129	delivery, or renewed on or after April 1, 2018. A group health
130	130	benefit plan that is delivered, issued for delivery, or renewed
131	131	before April 1, 2018, is governed by the law as it existed
132	132	immediately before the effective date of this Act, and that law is
133	133	continued in effect for that purpose.
134	134	SECTION 8. This Act takes effect December 1, 2017.