Texas 2021 - 87th Regular

Texas Senate Bill SB1141 Compare Versions

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

Old	New	Differences
1	1	87R3326 RDS-F
2	2	By: Zaffirini S.B. No. 1141
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to group health benefit plan coverage for early treatment
8	8	of first episode psychosis.
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) "First episode psychosis" means the initial onset
13	13	of psychosis or symptoms associated with psychosis, caused by:
14	14	(A) medical or neurological conditions;
15	15	(B) serious mental illness; or
16	16	(C) substance use.
17	17	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
18	18	amended by adding Section 1355.016 to read as follows:
19	19	Sec. 1355.016. REQUIRED COVERAGE FOR EARLY TREATMENT OF
20	20	FIRST EPISODE PSYCHOSIS. (a) A group health benefit plan must
21	21	provide coverage, based on medical necessity, as provided by this
22	22	section to an individual who is younger than 26 years of age and who
23	23	is diagnosed with first episode psychosis.
24	24	(b) The group health benefit plan must provide coverage
25	25	under this section to the enrollee for all generally recognized
26	26	services prescribed in relation to first episode psychosis.
27	27	(c) For purposes of Subsection (b), "generally recognized
28	28	services" include:
29	29	(1) coordinated specialty care for first episode
30	30	psychosis treatment, covering each element of the treatment model
31	31	included in the Recovery After an Initial Schizophrenia Episode
32	32	(RAISE) early treatment program study conducted by the National
33	33	Institute of Mental Health regarding treatment for psychosis, as
34	34	completed July 2017, including:
35	35	(A) psychotherapy;
36	36	(B) medication management;
37	37	(C) case management;
38	38	(D) family education and support; and
39	39	(E) education and employment support;
40	40	(2) assertive community treatment as described by the
41	41	Texas Health and Human Services Commission's Texas Resilience and
42	42	Recovery Utilization Management Guidelines: Adult Mental Health
43	43	Services, as updated in April 2017, or a more recently updated
44	44	version adopted by the commissioner; and
45	45	(3) peer support services, including:
46	46	(A) recovery and wellness support;
47	47	(B) mentoring; and
48	48	(C) advocacy.
49	49	(d) Only coordinated specialty care or assertive community
50	50	treatment provided by a provider that adheres to the fidelity of the
51	51	applicable treatment model and that has contracted with the Health
52	52	and Human Services Commission to provide coordinated specialty care
53	53	or assertive community treatment for first episode psychosis is
54	54	required to be covered under this section.
55	55	(e) If a group health benefit plan issuer credentials a
56	56	psychiatrist or licensed clinical leader of a treatment team to
57	57	provide generally recognized services for the treatment of first
58	58	episode psychosis, all members of the treatment team serving under
59	59	the credentialed psychiatrist or licensed clinical leader are
60	60	considered to be credentialed by the health benefit plan issuer.
61	61	(f) A group health benefit plan issuer shall reimburse a
62	62	provider of coordinated specialty care or assertive community
63	63	treatment for first episode psychosis based on a bundled payment
64	64	model instead of providing reimbursement for each service provided
65	65	to the enrollee by the member of a treatment team.
66	66	(g) If requested by a group health benefit plan issuer on or
67	67	after March 1, 2027, the department shall contract with an
68	68	independent third party with expertise in analyzing health benefit
69	69	plan premiums and costs to perform an independent analysis of the
70	70	impact of requiring coverage of the team-based treatment models
71	71	described by Subsection (c) on health benefit plan premiums.
72	72	Notwithstanding Subsection (c), if the analysis finds that premiums
73	73	increased annually by more than one percent solely due to requiring
74	74	coverage of a specific treatment model, a group health benefit plan
75	75	is not required to provide coverage under this section for that
76	76	treatment model.
77	77	SECTION 3. (a) As soon as practicable after the effective
78	78	date of this Act, the Texas Department of Insurance shall convene
79	79	and lead a work group that includes the Health and Human Services
80	80	Commission, providers of generally recognized services described
81	81	by Section 1355.016(c), Insurance Code, as added by this Act, and
82	82	group health benefit plan issuers. The work group shall:
83	83	(1) develop the criteria to be used to determine
84	84	medical necessity for purposes of coverage under Section 1355.016,
85	85	Insurance Code, as added by this Act; and
86	86	(2) determine a coding solution that allows for
87	87	coordinated specialty care and assertive community treatment to be
88	88	coded and reimbursed as a bundle of services as required under
89	89	Section 1355.016(f), Insurance Code, as added by this Act.
90	90	(b) Not later than January 1, 2022, the work group shall
91	91	make recommendations to the department based on its findings.
92	92	(c) Not later than March 30, 2022, the department shall
93	93	adopt rules:
94	94	(1) establishing the criteria to be used to determine
95	95	medical necessity under Section 1355.016(a), Insurance Code, as
96	96	added by this Act;
97	97	(2) creating a coding solution that allows for
98	98	reimbursement based on a bundled payment model for coordinated
99	99	specialty care and assertive community treatment as required by
100	100	Section 1355.016(f), Insurance Code, as added by this Act; and
101	101	(3) otherwise necessary to implement Section
102	102	1355.016, Insurance Code, as added by this Act.
103	103	SECTION 4. Section 1355.016, Insurance Code, as added by
104	104	this Act, applies only to a health benefit plan that is delivered,
105	105	issued for delivery, or renewed on or after March 30, 2022. A
106	106	health benefit plan delivered, issued for delivery, or renewed
107	107	before March 30, 2022, is governed by the law as it existed
108	108	immediately before that date, and that law is continued in effect
109	109	for that purpose.
110	110	SECTION 5. This Act takes effect September 1, 2021.