Texas 2025 - 89th Regular

Texas House Bill HB1594 Compare Versions

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

Old	New	Differences
1	1	89R5015 RDS-F
2	2	By: Plesa H.B. No. 1594
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to group health benefit plan coverage for early treatment
10	10	of first episode psychosis.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 1355.001, Insurance Code, is amended by
13	13	adding Subdivision (5) to read as follows:
14	14	(5) "First episode psychosis" means the initial onset
15	15	of psychosis or symptoms associated with psychosis, caused by:
16	16	(A) medical or neurological conditions;
17	17	(B) serious mental illness; or
18	18	(C) substance use.
19	19	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
20	20	amended by adding Section 1355.016 to read as follows:
21	21	Sec. 1355.016. REQUIRED COVERAGE FOR EARLY TREATMENT OF
22	22	FIRST EPISODE PSYCHOSIS. (a) A group health benefit plan must
23	23	provide coverage, based on medical necessity, as provided by this
24	24	section to an individual who is younger than 26 years of age and who
25	25	is diagnosed with first episode psychosis.
26	26	(b) The group health benefit plan must provide coverage
27	27	under this section to the enrollee for all generally recognized
28	28	services prescribed in relation to first episode psychosis.
29	29	(c) For purposes of Subsection (b), "generally recognized
30	30	services" include:
31	31	(1) coordinated specialty care for first episode
32	32	psychosis treatment, covering each element of the treatment model
33	33	included in the Recovery After an Initial Schizophrenia Episode
34	34	(RAISE) early treatment program study conducted by the National
35	35	Institute of Mental Health regarding treatment for psychosis, as
36	36	completed July 2017, including:
37	37	(A) psychotherapy;
38	38	(B) medication management;
39	39	(C) case management;
40	40	(D) family education and support; and
41	41	(E) education and employment support;
42	42	(2) assertive community treatment as described by the
43	43	Texas Health and Human Services Commission's Texas Resilience and
44	44	Recovery Utilization Management Guidelines: Adult Mental Health
45	45	Services, as updated in April 2017, or a more recently updated
46	46	version adopted by the commissioner; and
47	47	(3) peer support services, including:
48	48	(A) recovery and wellness support;
49	49	(B) mentoring; and
50	50	(C) advocacy.
51	51	(d) Only coordinated specialty care or assertive community
52	52	treatment provided by a provider that adheres to the fidelity of the
53	53	applicable treatment model and that has contracted with the Health
54	54	and Human Services Commission to provide coordinated specialty care
55	55	or assertive community treatment for first episode psychosis is
56	56	required to be covered under this section.
57	57	(e) If a group health benefit plan issuer credentials a
58	58	psychiatrist or licensed clinical leader of a treatment team to
59	59	provide generally recognized services for the treatment of first
60	60	episode psychosis, all members of the treatment team serving under
61	61	the credentialed psychiatrist or licensed clinical leader are
62	62	considered to be credentialed by the issuer.
63	63	(f) A group health benefit plan issuer shall reimburse a
64	64	provider of coordinated specialty care or assertive community
65	65	treatment for first episode psychosis based on a bundled payment
66	66	model instead of providing reimbursement for each service provided
67	67	to the enrollee by the member of a treatment team.
68	68	(g) If requested by a group health benefit plan issuer on or
69	69	after March 1, 2027, the department shall contract with an
70	70	independent third party with expertise in analyzing health benefit
71	71	plan premiums and costs to perform an independent analysis of the
72	72	impact of requiring coverage of the team-based treatment models
73	73	described by Subsection (c) on health benefit plan premiums.
74	74	Notwithstanding Subsection (c), if the analysis finds that premiums
75	75	increased annually by more than one percent solely due to requiring
76	76	coverage of a specific treatment model, a group health benefit plan
77	77	is not required to provide coverage under this section for that
78	78	treatment model.
79	79	SECTION 3. (a) As soon as practicable after the effective
80	80	date of this Act, the Texas Department of Insurance shall convene
81	81	and lead a work group that includes the Health and Human Services
82	82	Commission, providers of generally recognized services described
83	83	by Section 1355.016(c), Insurance Code, as added by this Act, and
84	84	group health benefit plan issuers. The work group shall:
85	85	(1) develop the criteria to be used to determine
86	86	medical necessity for purposes of coverage under Section 1355.016,
87	87	Insurance Code, as added by this Act; and
88	88	(2) determine a coding solution that allows for
89	89	coordinated specialty care and assertive community treatment to be
90	90	coded and reimbursed as a bundle of services as required under
91	91	Section 1355.016(f), Insurance Code, as added by this Act.
92	92	(b) Not later than January 1, 2026, the work group shall
93	93	make recommendations to the department based on its findings.
94	94	(c) Not later than March 30, 2026, the department shall
95	95	adopt rules:
96	96	(1) establishing the criteria to be used to determine
97	97	medical necessity under Section 1355.016(a), Insurance Code, as
98	98	added by this Act;
99	99	(2) creating a coding solution that allows for
100	100	reimbursement based on a bundled payment model for coordinated
101	101	specialty care and assertive community treatment as required by
102	102	Section 1355.016(f), Insurance Code, as added by this Act; and
103	103	(3) otherwise necessary to implement Section
104	104	1355.016, Insurance Code, as added by this Act.
105	105	SECTION 4. Section 1355.016, Insurance Code, as added by
106	106	this Act, applies only to a health benefit plan that is delivered,
107	107	issued for delivery, or renewed on or after March 30, 2026. A
108	108	health benefit plan delivered, issued for delivery, or renewed
109	109	before March 30, 2026, is governed by the law as it existed
110	110	immediately before that date, and that law is continued in effect
111	111	for that purpose.
112	112	SECTION 5. This Act takes effect September 1, 2025.