Texas 2019 - 86th Regular

Texas House Bill HB501 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~86R7290~~ PMO-F
	1	+	86R4495 PMO-F
2	2		By: Thompson of Harris H.B. No. 501
3		-	Substitute the following for H.B. No. 501:
4		-	By: Lucio III C.S.H.B. No. 501
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to the requirement and study of insurance coverage for
10	8		serious emotional disturbance of a child.
11	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	10		SECTION 1. Section 1355.001, Insurance Code, is amended by
13	11		adding Subdivision (5) to read as follows:
14	12		(5) "Serious emotional disturbance of a child" means
15	13		an emotional or behavioral disorder or a neuropsychiatric condition
16	14		that causes a person's functioning to be impaired in thought,
17	15		perception, affect, or behavior and that:
18	16		(A) has been diagnosed or identified, as
19	17		applicable, in a person who is at least three years of age and
20	18		younger than 18 years of age by:
21	19		(i) a physician licensed to practice
22	20		medicine in this state and practicing within the scope of the
23	21		physician's license; or
24		-	(ii) a psychologist, licensed ~~professional~~
25		-	counselor, licensed ~~marriage~~ and ~~family therapist, or licensed~~
26		-	~~clinical social worker~~ licensed ~~to practice in this state and~~
27		-	~~practicing within the scope of the applicable~~ license; and
	22	+	(ii) a psychologist or licensed
	23	+	professional counselor licensed to practice in this state and
	24	+	practicing within the scope of the psychologist's or licensed
	25	+	professional counselor's license; and
28	26		(B) meets at least one of the following criteria:
29	27		(i) the disorder substantially impairs the
30	28		person's ability in at least two of the following activities or
31	29		tasks:
32	30		(a) self-care;
33	31		(b) engaging in family relationships;
34	32		(c) functioning in school; or
35	33		(d) functioning in the community;
36	34		(ii) the disorder creates a risk that the
37	35		person will be removed from the person's home and placed in a more
38	36		restrictive environment, including in a facility or program
39	37		operated by the Department of Family and Protective Services or an
40	38		agency that is part of the juvenile justice system;
41	39		(iii) the disorder causes the person to:
42	40		(a) display psychotic features or
43	41		violent behavior; or
44	42		(b) pose a danger to the person's self
45	43		or others; or
46	44		(iv) the disorder results in the person
47	45		meeting state special education eligibility requirements for
48	46		emotional disturbance.
49	47		SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
50	48		amended by adding Section 1355.0041 to read as follows:
51	49		Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL
52	50		DISTURBANCE OF A CHILD. (a) Notwithstanding Section 1355.002,
53	51		this section does not apply to:
54	52		(1) a basic plan under Chapter 1575; or
55	53		(2) a primary care coverage plan under Chapter 1579.
56	54		(b) A group health benefit plan:
57	55		(1) must provide coverage for serious emotional
58	56		disturbance of a child, based on medical necessity, for not less
59	57		than the following treatments in each calendar year:
60	58		(A) 45 days of inpatient treatment; and
61	59		(B) 60 visits for outpatient treatment,
62	60		including group and individual outpatient treatment;
63	61		(2) may not include a lifetime limitation on the
64	62		number of days of inpatient treatment or the number of visits for
65	63		outpatient treatment covered under the plan; and
66	64		(3) must include the same amount limitations,
67	65		deductibles, copayments, and coinsurance factors for serious
68	66		emotional disturbance of a child as the plan includes for physical
69	67		illness.
70	68		(c) A group health benefit plan issuer:
71	69		(1) may not count an outpatient visit for medication
72	70		management against the number of outpatient visits required to be
73	71		covered under Subsection (b)(1)(B); and
74	72		(2) must provide coverage for an outpatient visit
75	73		described by Subsection (b)(1)(B) under the same terms as the
76	74		coverage the issuer provides for an outpatient visit for the
77	75		treatment of physical illness.
78	76		(d) The department shall conduct a study to determine and
79	77		evaluate the extent to which enrollees are making claims under
80	78		coverage for serious emotional disturbance of a child and the
81	79		impact, if any, the coverage for serious emotional disturbance of a
82	80		child and the claims have on the cost of the coverage for group
83	81		health benefit plans.
84	82		(e) Not later than August 1, 2020, the department shall
85	83		submit to the governor, the lieutenant governor, the speaker of the
86	84		house of representatives, and the appropriate standing committees
87	85		of the legislature a report regarding the results of the study
88	86		required by Subsection (d), together with any recommendations for
89	87		legislation.
90	88		(f) This subsection and Subsections (d) and (e) expire
91	89		September 1, 2021.
92	90		SECTION 3. Sections 1355.005 and 1355.007, Insurance Code,
93	91		are amended to read as follows:
94	92		Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A group
95	93		health benefit plan issuer may provide or offer coverage required
96	94		by Section 1355.004 or 1355.0041 through a managed care plan.
97	95		Sec. 1355.007. SMALL EMPLOYER COVERAGE. An issuer of a
98	96		group health benefit plan to a small employer must offer the
99	97		coverage described by Section 1355.004 or 1355.0041 to the employer
100	98		but is not required to provide the coverage if the employer rejects
101	99		the coverage.
102	100		SECTION 4. Section 1355.054(a), Insurance Code, is amended
103	101		to read as follows:
104	102		(a) Benefits of coverage provided under this subchapter may
105	103		be used only in a situation in which:
106	104		(1) the covered individual has a serious mental
107	105		illness or serious emotional disturbance of a child as defined by
108	106		Section 1355.001 that requires confinement of the individual in a
109	107		hospital unless treatment is available through a residential
110	108		treatment center for children and adolescents or a crisis
111	109		stabilization unit; and
112	110		(2) the covered individual's mental illness or
113	111		emotional disturbance:
114	112		(A) substantially impairs the individual's
115	113		thought, perception of reality, emotional process, or judgment; or
116	114		(B) as manifested by the individual's recent
117	115		disturbed behavior, grossly impairs the individual's behavior.
118	116		SECTION 5. The change in law made by this Act applies only
119	117		to a group health benefit plan that is delivered, issued for
120	118		delivery, or renewed on or after January 1, 2020. A group health
121	119		benefit plan that is delivered, issued for delivery, or renewed
122	120		before January 1, 2020, is governed by the law as it existed
123	121		immediately before the effective date of this Act, and that law is
124	122		continued in effect for that purpose.
125	123		SECTION 6. This Act takes effect September 1, 2019.