Texas 2021 - 87th Regular

Texas Senate Bill SB51 Compare Versions

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

Old	New	Differences
1	1	87R663 MEW-F
2	2	By: Zaffirini S.B. No. 51
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, licensed professional
23	23	counselor, licensed marriage and family therapist, or licensed
24	24	clinical social worker licensed to practice in this state and
25	25	practicing within the scope of the applicable license; and
26	26	(B) meets at least one of the following criteria:
27	27	(i) the disorder or condition substantially
28	28	impairs the person's ability in at least two of the following
29	29	activities or 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 or condition creates a
35	35	risk that the person will be removed from the person's home and
36	36	placed in a more restrictive environment, including in a facility
37	37	or program operated by the Department of Family and Protective
38	38	Services or an agency that is part of the juvenile justice system;
39	39	(iii) the disorder or condition causes the
40	40	person to:
41	41	(a) display psychotic features or
42	42	violent behavior; or
43	43	(b) pose a danger to the person's self
44	44	or others; or
45	45	(iv) the disorder or condition results in
46	46	the person meeting state special education eligibility
47	47	requirements for emotional disturbance.
48	48	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
49	49	amended by adding Section 1355.0041 to read as follows:
50	50	Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL
51	51	DISTURBANCE OF A CHILD. (a) Notwithstanding Section 1355.002, this
52	52	section does not apply to:
53	53	(1) a basic plan under Chapter 1575; or
54	54	(2) a primary care coverage plan under Chapter 1579.
55	55	(b) A group health benefit plan:
56	56	(1) must provide coverage for serious emotional
57	57	disturbance of a child, based on medical necessity, for not less
58	58	than the following treatments in each calendar year:
59	59	(A) 45 days of inpatient treatment; and
60	60	(B) 60 visits for outpatient treatment,
61	61	including group and individual outpatient treatment;
62	62	(2) may not include a lifetime limitation on the
63	63	number of days of inpatient treatment or the number of visits for
64	64	outpatient treatment covered under the plan; and
65	65	(3) must include the same amount limitations,
66	66	deductibles, copayments, and coinsurance factors for serious
67	67	emotional disturbance of a child as the plan includes for physical
68	68	illness.
69	69	(c) A group health benefit plan issuer:
70	70	(1) may not count an outpatient visit for medication
71	71	management against the number of outpatient visits required to be
72	72	covered under Subsection (b)(1)(B); and
73	73	(2) must provide coverage for an outpatient visit
74	74	described by Subsection (b)(1)(B) under the same terms as the
75	75	coverage the issuer provides for an outpatient visit for the
76	76	treatment of physical illness.
77	77	(d) The department shall conduct a study to determine and
78	78	evaluate the extent to which enrollees are making claims under
79	79	coverage for serious emotional disturbance of a child and the
80	80	impact, if any, the coverage for serious emotional disturbance of a
81	81	child and the claims have on the cost of the coverage for group
82	82	health benefit plans.
83	83	(e) Not later than August 1, 2022, the department shall
84	84	submit to the governor, the lieutenant governor, the speaker of the
85	85	house of representatives, and the appropriate standing committees
86	86	of the legislature a report regarding the results of the study
87	87	required by Subsection (d), together with any recommendations for
88	88	legislation.
89	89	(f) This subsection and Subsections (d) and (e) expire
90	90	September 1, 2023.
91	91	SECTION 3. Sections 1355.005 and 1355.007, Insurance Code,
92	92	are amended to read as follows:
93	93	Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A group
94	94	health benefit plan issuer may provide or offer coverage required
95	95	by Section 1355.004 or 1355.0041 through a managed care plan.
96	96	Sec. 1355.007. SMALL EMPLOYER COVERAGE. An issuer of a
97	97	group health benefit plan to a small employer must offer the
98	98	coverage described by Section 1355.004 or 1355.0041 to the employer
99	99	but is not required to provide the coverage if the employer rejects
100	100	the coverage.
101	101	SECTION 4. Section 1355.054(a), Insurance Code, is amended
102	102	to read as follows:
103	103	(a) Benefits of coverage provided under this subchapter may
104	104	be used only in a situation in which:
105	105	(1) the covered individual has a serious mental
106	106	illness or serious emotional disturbance of a child as defined by
107	107	Section 1355.001 that requires confinement of the individual in a
108	108	hospital unless treatment is available through a residential
109	109	treatment center for children and adolescents or a crisis
110	110	stabilization unit; and
111	111	(2) the covered individual's mental illness or
112	112	emotional disturbance:
113	113	(A) substantially impairs the individual's
114	114	thought, perception of reality, emotional process, or judgment; or
115	115	(B) as manifested by the individual's recent
116	116	disturbed behavior, grossly impairs the individual's behavior.
117	117	SECTION 5. The change in law made by this Act applies only
118	118	to a group health benefit plan that is delivered, issued for
119	119	delivery, or renewed on or after January 1, 2022. A group health
120	120	benefit plan that is delivered, issued for delivery, or renewed
121	121	before January 1, 2022, is governed by the law as it existed
122	122	immediately before the effective date of this Act, and that law is
123	123	continued in effect for that purpose.
124	124	SECTION 6. This Act takes effect September 1, 2021.