Texas 2019 - 86th Regular

Texas Senate Bill SB2218 Compare Versions

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

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1	1	By: Zaffirini S.B. No. 2218
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to coverage for serious mental illness, other disorders,
7	7	and chemical dependency under certain health benefit plans.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. The heading to Subchapter A, Chapter 1355,
10	10	Insurance Code, is amended to read as follows:
11	11	SUBCHAPTER A. [GROUP] HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN
12	12	SERIOUS MENTAL ILLNESSES AND OTHER DISORDERS
13	13	SECTION 2. Section 1355.002, Insurance Code, is amended by
14	14	amending Subsection (a) and adding Subsections (c) and (d) to read
15	15	as follows:
16	16	(a) This subchapter applies only to a [group] health benefit
17	17	plan that provides benefits for medical or surgical expenses
18	18	incurred as a result of a health condition, accident, or sickness,
19	19	including:
20	20	(1) an individual, [a] group, blanket, or franchise
21	21	insurance policy or [, group] insurance agreement, a group hospital
22	22	service contract, [or] an individual or group evidence of coverage,
23	23	or a similar coverage document, that is offered by:
24	24	(A) an insurance company;
25	25	(B) a group hospital service corporation
26	26	operating under Chapter 842;
27	27	(C) a fraternal benefit society operating under
28	28	Chapter 885;
29	29	(D) a stipulated premium company operating under
30	30	Chapter 884; [or]
31	31	(E) a health maintenance organization operating
32	32	under Chapter 843; [and]
33	33	(F) an exchange operating under Chapter 942;
34	34	(G) a Lloyd's plan operating under Chapter 941;
35	35	(H) an approved nonprofit health corporation
36	36	that holds a certificate of authority under Chapter 844; or
37	37	(I) a multiple employer welfare arrangement that
38	38	holds a certificate of authority under Chapter 846; and
39	39	(2) to the extent permitted by the Employee Retirement
40	40	Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a plan
41	41	offered under:
42	42	(A) a multiple employer welfare arrangement as
43	43	defined by Section 3 of that Act; or
44	44	(B) another analogous benefit arrangement.
45	45	(c) Notwithstanding any other law, this subchapter applies
46	46	to:
47	47	(1) a small employer health benefit plan subject to
48	48	Chapter 1501, including coverage provided through a health group
49	49	cooperative under Subchapter B of that chapter; and
50	50	(2) a standard health benefit plan issued under
51	51	Chapter 1507.
52	52	SECTION 3. The heading to Section 1355.003, Insurance Code,
53	53	is amended to read as follows:
54	54	Sec. 1355.003. EXCEPTIONS [EXCEPTION].
55	55	SECTION 4. Section 1355.003, Insurance Code, is amended by
56	56	amending Subsection (a) and adding Subsection (c) to read as
57	57	follows:
58	58	(a) This subchapter does not apply to coverage under:
59	59	(1) [a blanket accident and health insurance policy,
60	60	as described by Chapter 1251;
61	61	[(2)] a short-term travel policy;
62	62	(2) [(3)] an accident-only policy;
63	63	(3) [(4)] a limited or specified-disease policy that
64	64	does not provide benefits for mental health care or similar
65	65	services;
66	66	(4) [(5)] except as provided by Subsection (b), a plan
67	67	offered under Chapter 1551 or Chapter 1601;
68	68	(5) [(6)] a plan offered in accordance with Section
69	69	1355.151; or
70	70	(6) [(7)] a Medicare supplement benefit plan, as
71	71	defined by Section 1652.002.
72	72	(c) To the extent that this section would otherwise require
73	73	this state to make a payment under 42 U.S.C. Section
74	74	18031(d)(3)(B)(ii), a qualified health plan, as defined by 45
75	75	C.F.R. Section 155.20, is not required to provide a benefit under
76	76	this subchapter that exceeds the specified essential health
77	77	benefits required under 42 U.S.C. Section 18022(b).
78	78	SECTION 5. Section 1355.004, Insurance Code, is amended to
79	79	read as follows:
80	80	Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL
81	81	ILLNESS. (a) A [group] health benefit plan:
82	82	(1) must provide coverage, based on medical necessity,
83	83	for not less than the following treatments of serious mental
84	84	illness in each calendar year:
85	85	(A) 45 days of inpatient treatment; and
86	86	(B) 60 visits for outpatient treatment,
87	87	including group and individual outpatient treatment;
88	88	(2) may not include a lifetime limitation on the
89	89	number of days of inpatient treatment or the number of visits for
90	90	outpatient treatment covered under the plan; and
91	91	(3) must include the same amount limitations,
92	92	deductibles, copayments, and coinsurance factors for serious
93	93	mental illness as the plan includes for physical illness.
94	94	(b) A [group] health benefit plan issuer:
95	95	(1) may not count an outpatient visit for medication
96	96	management against the number of outpatient visits required to be
97	97	covered under Subsection (a)(1)(B); and
98	98	(2) must provide coverage for an outpatient visit
99	99	described by Subsection (a)(1)(B) under the same terms as the
100	100	coverage the issuer provides for an outpatient visit for the
101	101	treatment of physical illness.
102	102	SECTION 6. Section 1355.005, Insurance Code, is amended to
103	103	read as follows:
104	104	Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A [group]
105	105	health benefit plan issuer may provide or offer coverage required
106	106	by Section 1355.004 through a managed care plan.
107	107	SECTION 7. Section 1355.006(b), Insurance Code, is amended
108	108	to read as follows:
109	109	(b) This subchapter does not require a [group] health
110	110	benefit plan to provide coverage for the treatment of:
111	111	(1) addiction to a controlled substance or marihuana
112	112	that is used in violation of law; or
113	113	(2) mental illness that results from the use of a
114	114	controlled substance or marihuana in violation of law.
115	115	SECTION 8. Section 1368.002, Insurance Code, is amended to
116	116	read as follows:
117	117	Sec. 1368.002. APPLICABILITY OF CHAPTER. (a) This chapter
118	118	applies only to a [group] health benefit plan that provides
119	119	hospital and medical coverage or services on an expense incurred,
120	120	service, or prepaid basis, including an individual, [a] group,
121	121	blanket, or franchise insurance policy or insurance agreement, a
122	122	group hospital service contract, an individual or group evidence of
123	123	coverage, or a similar coverage document, or a self-funded or
124	124	self-insured plan or arrangement, that is offered in this state by:
125	125	(1) an insurer;
126	126	(2) a group hospital service corporation operating
127	127	under Chapter 842;
128	128	(3) a health maintenance organization operating under
129	129	Chapter 843; [or]
130	130	(4) an employer, trustee, or other self-funded or
131	131	self-insured plan or arrangement;
132	132	(5) a fraternal benefit society operating under
133	133	Chapter 885;
134	134	(6) a stipulated premium company operating under
135	135	Chapter 884;
136	136	(7) an exchange operating under Chapter 942;
137	137	(8) a Lloyd's plan operating under Chapter 941;
138	138	(9) an approved nonprofit health corporation that
139	139	holds a certificate of authority under Chapter 844; or
140	140	(10) a multiple employer welfare arrangement that
141	141	holds a certificate of authority under Chapter 846.
142	142	(b) Notwithstanding any other law, this chapter applies to:
143	143	(1) a small employer health benefit plan subject to
144	144	Chapter 1501, including coverage provided through a health group
145	145	cooperative under Subchapter B of that chapter; and
146	146	(2) a standard health benefit plan issued under
147	147	Chapter 1507.
148	148	SECTION 9. Section 1368.003, Insurance Code, is amended to
149	149	read as follows:
150	150	Sec. 1368.003. EXCEPTIONS [EXCEPTION]. (a) This chapter
151	151	does not apply to:
152	152	(1) an employer, trustee, or other self-funded or
153	153	self-insured plan or arrangement with 250 or fewer employees or
154	154	members;
155	155	(2) [an individual insurance policy;
156	156	[(3) an individual evidence of coverage issued by a
157	157	health maintenance organization;
158	158	[(4)] a health insurance policy that provides only:
159	159	(A) cash indemnity for hospital or other
160	160	confinement benefits;
161	161	(B) supplemental or limited benefit coverage;
162	162	(C) coverage for specified diseases or
163	163	accidents;
164	164	(D) disability income coverage; or
165	165	(E) any combination of those benefits or
166	166	coverages;
167	167	(3) [(5) a blanket insurance policy;
168	168	[(6)] a short-term travel insurance policy;
169	169	(4) [(7)] an accident-only insurance policy;
170	170	(5) [(8)] a limited or specified disease insurance
171	171	policy;
172	172	(6) [(9) an individual conversion insurance policy
173	173	or contract;
174	174	[(10)] a policy or contract designed for issuance to a
175	175	person eligible for Medicare coverage or other similar coverage
176	176	under a state or federal government plan; or
177	177	(7) [(11)] an evidence of coverage provided by a
178	178	health maintenance organization if the plan holder is the subject
179	179	of a collective bargaining agreement that was in effect on January
180	180	1, 1982, and that has not expired since that date.
181	181	(b) To the extent that this section would otherwise require
182	182	this state to make a payment under 42 U.S.C. Section
183	183	18031(d)(3)(B)(ii), a qualified health plan, as defined by 45
184	184	C.F.R. Section 155.20, is not required to provide a benefit under
185	185	this chapter that exceeds the specified essential health benefits
186	186	required under 42 U.S.C. Section 18022(b).
187	187	SECTION 10. Section 1368.004, Insurance Code, is amended to
188	188	read as follows:
189	189	Sec. 1368.004. COVERAGE REQUIRED. (a) A [group] health
190	190	benefit plan shall provide coverage for the necessary care and
191	191	treatment of chemical dependency.
192	192	(b) Coverage required under this section may be provided:
193	193	(1) directly by the [group] health benefit plan
194	194	issuer; or
195	195	(2) by another entity, including a single service
196	196	health maintenance organization, under contract with the [group]
197	197	health benefit plan issuer.
198	198	SECTION 11. Section 1368.005(b), Insurance Code, is amended
199	199	to read as follows:
200	200	(b) A [group] health benefit plan may set dollar or
201	201	durational limits for coverage required under this chapter that are
202	202	less favorable than for coverage provided for physical illness
203	203	generally under the plan if those limits are sufficient to provide
204	204	appropriate care and treatment under the guidelines and standards
205	205	adopted under Section 1368.007. If guidelines and standards
206	206	adopted under Section 1368.007 are not in effect, the dollar and
207	207	durational limits may not be less favorable than for physical
208	208	illness generally.
209	209	SECTION 12. Section 1355.007, Insurance Code, is repealed.
210	210	SECTION 13. The changes in law made by this Act apply only
211	211	to a health benefit plan that is delivered, issued for delivery, or
212	212	renewed on or after January 1, 2020. A health benefit plan that is
213	213	delivered, issued for delivery, or renewed before January 1, 2020,
214	214	is governed by the law as it existed immediately before the
215	215	effective date of this Act, and that law is continued in effect for
216	216	that purpose.
217	217	SECTION 14. This Act takes effect September 1, 2019.