Texas 2023 - 88th Regular

Texas Senate Bill SB1220 Compare Versions

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1	1	88R7329 RDS-F
2	2	By: Zaffirini S.B. No. 1220
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. Section 1355.002, Insurance Code, is amended by
18	18	adding Subsection (c) to read as follows:
19	19	(c) Notwithstanding any other law, Section 1355.016 applies
20	20	to the state Medicaid program, including the Medicaid managed care
21	21	program operated under Chapter 533, Government Code.
22	22	SECTION 3. Subchapter A, Chapter 1355, Insurance Code, is
23	23	amended by adding Section 1355.016 to read as follows:
24	24	Sec. 1355.016. REQUIRED COVERAGE FOR EARLY TREATMENT OF
25	25	FIRST EPISODE PSYCHOSIS. (a) A group health benefit plan must
26	26	provide coverage, based on medical necessity, as provided by this
27	27	section to an individual who is younger than 26 years of age and who
28	28	is diagnosed with first episode psychosis.
29	29	(b) The group health benefit plan must provide coverage
30	30	under this section to the enrollee for all generally recognized
31	31	services prescribed in relation to first episode psychosis.
32	32	(c) For purposes of Subsection (b), "generally recognized
33	33	services" include:
34	34	(1) coordinated specialty care for first episode
35	35	psychosis treatment, covering each element of the treatment model
36	36	included in the Recovery After an Initial Schizophrenia Episode
37	37	(RAISE) early treatment program study conducted by the National
38	38	Institute of Mental Health regarding treatment for psychosis, as
39	39	completed July 2017, including:
40	40	(A) psychotherapy;
41	41	(B) medication management;
42	42	(C) case management;
43	43	(D) family education and support; and
44	44	(E) education and employment support;
45	45	(2) assertive community treatment as described by the
46	46	Texas Health and Human Services Commission's Texas Resilience and
47	47	Recovery Utilization Management Guidelines: Adult Mental Health
48	48	Services, as updated in April 2017, or a more recently updated
49	49	version adopted by the commissioner; and
50	50	(3) peer support services, including:
51	51	(A) recovery and wellness support;
52	52	(B) mentoring; and
53	53	(C) advocacy.
54	54	(d) Only coordinated specialty care or assertive community
55	55	treatment provided by a provider that adheres to the fidelity of the
56	56	applicable treatment model and that has contracted with the Health
57	57	and Human Services Commission to provide coordinated specialty care
58	58	or assertive community treatment for first episode psychosis is
59	59	required to be covered under this section.
60	60	(e) If a group health benefit plan issuer credentials a
61	61	psychiatrist or licensed clinical leader of a treatment team to
62	62	provide generally recognized services for the treatment of first
63	63	episode psychosis, all members of the treatment team serving under
64	64	the credentialed psychiatrist or licensed clinical leader are
65	65	considered to be credentialed by the health benefit plan issuer.
66	66	(f) A group health benefit plan issuer shall reimburse a
67	67	provider of coordinated specialty care or assertive community
68	68	treatment for first episode psychosis based on a bundled payment
69	69	model instead of providing reimbursement for each service provided
70	70	to the enrollee by the member of a treatment team.
71	71	(g) If requested by a group health benefit plan issuer on or
72	72	after March 1, 2029, the department shall contract with an
73	73	independent third party with expertise in analyzing health benefit
74	74	plan premiums and costs to perform an independent analysis of the
75	75	impact of requiring coverage of the team-based treatment models
76	76	described by Subsection (c) on health benefit plan premiums.
77	77	Notwithstanding Subsection (c), if the analysis finds that premiums
78	78	increased annually by more than one percent solely due to requiring
79	79	coverage of a specific treatment model, a group health benefit plan
80	80	is not required to provide coverage under this section for that
81	81	treatment model.
82	82	SECTION 4. (a) As soon as practicable after the effective
83	83	date of this Act, the Texas Department of Insurance shall convene
84	84	and lead a work group that includes the Health and Human Services
85	85	Commission, providers of generally recognized services described
86	86	by Section 1355.016(c), Insurance Code, as added by this Act, and
87	87	group health benefit plan issuers. The work group shall:
88	88	(1) develop the criteria to be used to determine
89	89	medical necessity for purposes of coverage under Section 1355.016,
90	90	Insurance Code, as added by this Act; and
91	91	(2) determine a coding solution that allows for
92	92	coordinated specialty care and assertive community treatment to be
93	93	coded and reimbursed as a bundle of services as required under
94	94	Section 1355.016(f), Insurance Code, as added by this Act.
95	95	(b) Not later than January 1, 2024, the work group shall
96	96	make recommendations to the department based on its findings.
97	97	(c) Not later than March 30, 2024, the department shall
98	98	adopt rules:
99	99	(1) establishing the criteria to be used to determine
100	100	medical necessity under Section 1355.016(a), Insurance Code, as
101	101	added by this Act;
102	102	(2) creating a coding solution that allows for
103	103	reimbursement based on a bundled payment model for coordinated
104	104	specialty care and assertive community treatment as required by
105	105	Section 1355.016(f), Insurance Code, as added by this Act; and
106	106	(3) otherwise necessary to implement Section
107	107	1355.016, Insurance Code, as added by this Act.
108	108	SECTION 5. If before implementing any provision of this Act
109	109	a state agency determines that a waiver or authorization from a
110	110	federal agency is necessary for implementation of that provision,
111	111	the agency affected by the provision shall request the waiver or
112	112	authorization and may delay implementing that provision until the
113	113	waiver or authorization is granted.
114	114	SECTION 6. Section 1355.016, Insurance Code, as added by
115	115	this Act, applies only to a health benefit plan that is delivered,
116	116	issued for delivery, or renewed on or after March 30, 2024. A
117	117	health benefit plan delivered, issued for delivery, or renewed
118	118	before March 30, 2024, is governed by the law as it existed
119	119	immediately before that date, and that law is continued in effect
120	120	for that purpose.
121	121	SECTION 7. This Act takes effect September 1, 2023.