88R9546 KBB-D
By: Turner H.B. No. 5121
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage of treatment for chemical
dependency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1368.001(2), Insurance Code, is amended
to read as follows:
(2) "Chemical dependency treatment center" means a
facility that provides a program for the treatment of chemical
dependency under a written treatment plan approved and monitored by
a physician and that is:
(A) affiliated with a hospital under a
contractual agreement with an established system for patient
referral;
(B) accredited as a chemical dependency
treatment center by the Joint Commission on Accreditation of
Healthcare Organizations;
(C) licensed as a chemical dependency treatment
program by the Health and Human Services [Texas] Commission [on
Alcohol and Drug Abuse]; or
(D) licensed, certified, or approved as a
chemical dependency treatment program or center by another state
agency.
SECTION 2. Sections 1368.002, 1368.003, and 1368.004,
Insurance Code, are amended to read as follows:
Sec. 1368.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a [group] health benefit plan that provides
hospital and medical coverage or services on an expense incurred,
service, or prepaid basis, including an individual or a group
insurance policy or contract or self-funded or self-insured plan or
arrangement that is offered in this state by:
(1) an insurer;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843; or
(4) an employer, trustee, or other self-funded or
self-insured plan or arrangement.
(b) Notwithstanding any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
or
(4) a plan providing basic coverage under Chapter
1601.
Sec. 1368.003. EXCEPTION. This chapter does not apply to:
(1) [an employer, trustee, or other self-funded or
self-insured plan or arrangement with 250 or fewer employees or
members;
[(2) an individual insurance policy;
[(3) an individual evidence of coverage issued by a
health maintenance organization;
[(4)] a health insurance policy that provides only:
(A) cash indemnity for hospital or other
confinement benefits;
(B) supplemental or limited benefit coverage;
(C) coverage for specified diseases or
accidents;
(D) disability income coverage; or
(E) any combination of those benefits or
coverages;
(2) [(5)] a blanket insurance policy;
(3) [(6)] a short-term travel insurance policy;
(4) [(7)] an accident-only insurance policy;
(5) [(8)] a limited or specified disease insurance
policy;
(6) [(9)] an individual conversion insurance policy
or contract;
(7) [(10)] a policy or contract designed for issuance
to a person eligible for Medicare coverage or other similar
coverage under a state or federal government plan; or
(8) [(11)] an evidence of coverage provided by a
health maintenance organization if the plan holder is the subject
of a collective bargaining agreement that was in effect on January
1, 1982, and that has not expired since that date.
Sec. 1368.004. COVERAGE REQUIRED. (a) A [group] health
benefit plan shall provide coverage for the necessary care and
treatment of chemical dependency.
(b) Coverage required under this section may be provided:
(1) directly by the [group] health benefit plan
issuer; or
(2) by another entity, including a single service
health maintenance organization, under contract with the [group]
health benefit plan issuer.
SECTION 3. Section 1368.005(a), Insurance Code, is amended
to read as follows:
(a) Coverage [Except as provided by Subsection (b),
coverage] required under this chapter[:
[(1)] may not be less favorable than coverage provided
for physical illness generally under the plan[; and
[(2) shall be subject to the same durational limits,
dollar limits, deductibles, and coinsurance factors that apply to
coverage provided for physical illness generally under the plan].
SECTION 4. The heading to Section 1368.006, Insurance Code,
is amended to read as follows:
Sec. 1368.006. LIFETIME LIMITATION ON COVERAGE PROHIBITED.
SECTION 5. Section 1368.006(b), Insurance Code, is amended
to read as follows:
(b) Coverage [Notwithstanding Section 1368.005, coverage]
required under this chapter may not be subject [is limited] to a
lifetime maximum [of three separate treatment series for each
covered individual].
SECTION 6. Sections 1368.007(a) and (b), Insurance Code,
are amended to read as follows:
(a) Coverage provided under this chapter for necessary care
and treatment in a chemical dependency treatment center must be
provided at an appropriate level of [as if the] care [and treatment
were provided in a hospital].
(b) The department by rule shall adopt standards formulated
and approved by the department and the Health and Human Services
Commission [Texas Commission on Alcohol and Drug Abuse] for use by
insurers, other third-party reimbursement sources, and chemical
dependency treatment centers.
SECTION 7. Sections 1368.005(b) and 1368.006(a), Insurance
Code, are repealed.
SECTION 8. The changes in law made by this Act apply only to
a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2024. A health benefit plan
delivered, issued for delivery, or renewed before January 1, 2024,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 9. This Act takes effect September 1, 2023.