| 1 | 1 | | By: Menéndez S.B. No. 107 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | A BILL TO BE ENTITLED |
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| 5 | 5 | | AN ACT |
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| 6 | 6 | | relating to coverage for serious mental illness under certain group |
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| 7 | 7 | | health benefit plans. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Section 1355.001, Insurance Code, is amended by |
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| 10 | 10 | | amending Subdivision (1) and adding Subdivision (5) to read as |
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| 11 | 11 | | follows: |
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| 12 | 12 | | (1) "Serious mental illness" means the following |
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| 13 | 13 | | psychiatric illnesses as defined by the American Psychiatric |
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| 14 | 14 | | Association in the Diagnostic and Statistical Manual of Mental |
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| 15 | 15 | | Disorders (DSM), fifth edition, or a later edition adopted by the |
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| 16 | 16 | | commissioner: |
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| 17 | 17 | | (A) bipolar disorders (hypomanic, manic, |
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| 18 | 18 | | depressive, and mixed); |
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| 19 | 19 | | (B) depression in childhood and adolescence; |
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| 20 | 20 | | (C) major depressive disorders (single episode |
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| 21 | 21 | | or recurrent); |
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| 22 | 22 | | (D) obsessive-compulsive disorders; |
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| 23 | 23 | | (E) paranoid and other psychotic disorders; |
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| 24 | 24 | | (F) posttraumatic stress disorder; |
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| 25 | 25 | | (G) schizo-affective disorders (bipolar or |
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| 26 | 26 | | depressive); and |
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| 27 | 27 | | (H) [(G)] schizophrenia. |
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| 28 | 28 | | (5) "Posttraumatic stress disorder" means a disorder |
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| 29 | 29 | | that: |
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| 30 | 30 | | (A) meets the diagnostic criteria for |
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| 31 | 31 | | posttraumatic stress disorder specified by the American |
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| 32 | 32 | | Psychiatric Association in the Diagnostic and Statistical Manual of |
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| 33 | 33 | | Mental Disorders, fifth edition, or a later edition adopted by the |
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| 34 | 34 | | commissioner; and |
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| 35 | 35 | | (B) results in an impairment of a person's |
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| 36 | 36 | | functioning in the person's community, employment, family, school, |
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| 37 | 37 | | or social group. |
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| 38 | 38 | | SECTION 2. The heading to Section 1355.003, Insurance Code, |
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| 39 | 39 | | is amended to read as follows: |
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| 40 | 40 | | Sec. 1355.003. EXCEPTIONS [EXCEPTION]. |
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| 41 | 41 | | SECTION 3. Section 1355.003, Insurance Code, is amended by |
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| 42 | 42 | | adding Subsection (c) to read as follows: |
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| 43 | 43 | | (c) This subchapter, or the applicable portion of this |
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| 44 | 44 | | subchapter, does not apply to a qualified health plan to the extent |
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| 45 | 45 | | that a determination is made under 45 C.F.R. Section 155.170 that: |
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| 46 | 46 | | (1) this subchapter or a portion of this subchapter |
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| 47 | 47 | | requires the plan to offer benefits in addition to the essential |
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| 48 | 48 | | health benefits required under 42 U.S.C. Section 18022(b); and |
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| 49 | 49 | | (2) this state is required to defray the cost of the |
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| 50 | 50 | | benefits mandated under this subchapter or a portion of this |
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| 51 | 51 | | subchapter. |
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| 52 | 52 | | SECTION 4. The change in law made by this Act applies only |
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| 53 | 53 | | to a group health benefit plan that is delivered, issued for |
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| 54 | 54 | | delivery, or renewed on or after January 1, 2018. A group health |
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| 55 | 55 | | benefit plan that is delivered, issued for delivery, or renewed |
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| 56 | 56 | | before January 1, 2018, is governed by the law as it existed |
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| 57 | 57 | | immediately before the effective date of this Act, and that law is |
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| 58 | 58 | | continued in effect for that purpose. |
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| 59 | 59 | | SECTION 5. This Act takes effect September 1, 2017. |
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