Texas 2019 - 86th Regular

Texas Senate Bill SB314 Compare Versions

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

Old	New	Differences
1	1	86R4495 PMO-F
2	2	By: Zaffirini S.B. No. 314
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 or identified, as
17	17	applicable, in a person who is at least three years of age and
18	18	younger than 18 years of age by:
19	19	(i) a physician licensed to practice
20	20	medicine in this state and practicing within the scope of the
21	21	physician's license; or
22	22	(ii) a psychologist or licensed
23	23	professional counselor licensed to practice in this state and
24	24	practicing within the scope of the psychologist's or licensed
25	25	professional counselor's license; and
26	26	(B) meets at least one of the following criteria:
27	27	(i) the disorder substantially impairs the
28	28	person's ability in at least two of the following activities or
29	29	tasks:
30	30	(a) self-care;
31	31	(b) engaging in family relationships;
32	32	(c) functioning in school; or
33	33	(d) functioning in the community;
34	34	(ii) the disorder creates a risk that the
35	35	person will be removed from the person's home and placed in a more
36	36	restrictive environment, including in a facility or program
37	37	operated by the Department of Family and Protective Services or an
38	38	agency that is part of the juvenile justice system;
39	39	(iii) the disorder causes the person to:
40	40	(a) display psychotic features or
41	41	violent behavior; or
42	42	(b) pose a danger to the person's self
43	43	or others; or
44	44	(iv) the disorder results in the person
45	45	meeting state special education eligibility requirements for
46	46	emotional disturbance.
47	47	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
48	48	amended by adding Section 1355.0041 to read as follows:
49	49	Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL
50	50	DISTURBANCE OF A CHILD. (a) Notwithstanding Section 1355.002,
51	51	this section does not apply to:
52	52	(1) a basic plan under Chapter 1575; or
53	53	(2) a primary care coverage plan under Chapter 1579.
54	54	(b) A group health benefit plan:
55	55	(1) must provide coverage for serious emotional
56	56	disturbance of a child, based on medical necessity, for not less
57	57	than the following treatments in each calendar year:
58	58	(A) 45 days of inpatient treatment; and
59	59	(B) 60 visits for outpatient treatment,
60	60	including group and individual outpatient treatment;
61	61	(2) may not include a lifetime limitation on the
62	62	number of days of inpatient treatment or the number of visits for
63	63	outpatient treatment covered under the plan; and
64	64	(3) must include the same amount limitations,
65	65	deductibles, copayments, and coinsurance factors for serious
66	66	emotional disturbance of a child as the plan includes for physical
67	67	illness.
68	68	(c) A group health benefit plan issuer:
69	69	(1) may not count an outpatient visit for medication
70	70	management against the number of outpatient visits required to be
71	71	covered under Subsection (b)(1)(B); and
72	72	(2) must provide coverage for an outpatient visit
73	73	described by Subsection (b)(1)(B) under the same terms as the
74	74	coverage the issuer provides for an outpatient visit for the
75	75	treatment of physical illness.
76	76	(d) The department shall conduct a study to determine and
77	77	evaluate the extent to which enrollees are making claims under
78	78	coverage for serious emotional disturbance of a child and the
79	79	impact, if any, the coverage for serious emotional disturbance of a
80	80	child and the claims have on the cost of the coverage for group
81	81	health benefit plans.
82	82	(e) Not later than August 1, 2020, the department shall
83	83	submit to the governor, the lieutenant governor, the speaker of the
84	84	house of representatives, and the appropriate standing committees
85	85	of the legislature a report regarding the results of the study
86	86	required by Subsection (d), together with any recommendations for
87	87	legislation.
88	88	(f) This subsection and Subsections (d) and (e) expire
89	89	September 1, 2021.
90	90	SECTION 3. Sections 1355.005 and 1355.007, Insurance Code,
91	91	are amended to read as follows:
92	92	Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A group
93	93	health benefit plan issuer may provide or offer coverage required
94	94	by Section 1355.004 or 1355.0041 through a managed care plan.
95	95	Sec. 1355.007. SMALL EMPLOYER COVERAGE. An issuer of a
96	96	group health benefit plan to a small employer must offer the
97	97	coverage described by Section 1355.004 or 1355.0041 to the employer
98	98	but is not required to provide the coverage if the employer rejects
99	99	the coverage.
100	100	SECTION 4. Section 1355.054(a), Insurance Code, is amended
101	101	to read as follows:
102	102	(a) Benefits of coverage provided under this subchapter may
103	103	be used only in a situation in which:
104	104	(1) the covered individual has a serious mental
105	105	illness or serious emotional disturbance of a child as defined by
106	106	Section 1355.001 that requires confinement of the individual in a
107	107	hospital unless treatment is available through a residential
108	108	treatment center for children and adolescents or a crisis
109	109	stabilization unit; and
110	110	(2) the covered individual's mental illness or
111	111	emotional disturbance:
112	112	(A) substantially impairs the individual's
113	113	thought, perception of reality, emotional process, or judgment; or
114	114	(B) as manifested by the individual's recent
115	115	disturbed behavior, grossly impairs the individual's behavior.
116	116	SECTION 5. The change in law made by this Act applies only
117	117	to a group health benefit plan that is delivered, issued for
118	118	delivery, or renewed on or after January 1, 2020. A group health
119	119	benefit plan that is delivered, issued for delivery, or renewed
120	120	before January 1, 2020, is governed by the law as it existed
121	121	immediately before the effective date of this Act, and that law is
122	122	continued in effect for that purpose.
123	123	SECTION 6. This Act takes effect September 1, 2019.