88R12761 EAS-F
By: Bucy H.B. No. 3566
A BILL TO BE ENTITLED
AN ACT
relating to statewide standards for the provision of and health
benefit plan coverage of substance use and addiction treatment.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 542 to read as follows:
CHAPTER 542. SUBSTANCE USE AND ADDICTION TREATMENT
Sec. 542.001. STANDARDS FOR SUBSTANCE USE AND ADDICTION
TREATMENT. In carrying out the commission's duties under law in
relation to the provision of substance use and addiction treatment,
including the designation of appropriate levels of care, the
transfer or discharge of a patient, and the utilization management
review of care and treatment provided to individuals suffering from
a substance use, mental health, or co-occurring disorder, the
commission shall endeavor to use and encourage the use of the most
recently published standards on substance use and addiction
treatment by the American Society of Addiction Medicine, including
the use of those standards for determining the level of care and
authorizing payment commensurate with the level of care indicated
by a health benefit plan.
Sec. 542.002. MEMORANDUM OF UNDERSTANDING. To encourage
the use of standards described by Section 542.001 by other state
agencies and local governmental entities, the commission may adopt
a memorandum of understanding with those agencies and entities to
coordinate the use of and authorize the payment for services
delivered in accordance with those standards.
SECTION 2. Chapter 1355, Insurance Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G. CLASSIFICATION AND DETERMINATION OF COVERAGE FOR
MENTAL ILLNESS
Sec. 1355.301. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(10) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(11) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 533,
Government Code;
(12) the child health plan program under Chapter 62,
Health and Safety Code;
(13) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(14) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(15) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(16) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1355.302. REQUIRED USE OF MANUAL. A health benefit
plan that provides coverage for mental health or substance use
disorders must use the Diagnostic and Statistical Manual of Mental
Disorders, 5th edition, for purposes of classifying and determining
coverage for mental illness.
SECTION 3. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 4. Section 1355.302, Insurance Code, as added by
this Act, applies only to a health benefit plan that is delivered,
issued for delivery, or renewed on or after January 1, 2024.
SECTION 5. This Act takes effect September 1, 2023.