Texas 2025 - 89th Regular

Texas House Bill HB709 Compare Versions

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

Old	New	Differences
1	1	89R679 MEW-F
2	2	By: Thompson H.B. No. 709
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the requirement and study of insurance coverage for
10	10	serious emotional disturbance of a child.
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) "Serious emotional disturbance of a child" means a
15	15	diagnosable mental, behavioral, or emotional disorder of
16	16	sufficient duration to meet diagnostic criteria specified in the
17	17	Diagnostic and Statistical Manual of Mental Disorders that results
18	18	in functional impairment that substantially interferes with or
19	19	limits a child's role or functioning in family, school, or
20	20	community services and that:
21	21	(A) has been diagnosed or identified, as
22	22	applicable, in a person who is at least three years of age and
23	23	younger than 18 years of age by:
24	24	(i) a physician licensed to practice
25	25	medicine in this state and practicing within the scope of the
26	26	physician's license; or
27	27	(ii) a psychologist, licensed professional
28	28	counselor, licensed marriage and family therapist, or licensed
29	29	clinical social worker licensed to practice in this state and
30	30	practicing within the scope of the applicable license; and
31	31	(B) meets at least one of the following criteria:
32	32	(i) the disorder substantially impairs the
33	33	person's ability in at least two of the following activities or
34	34	tasks:
35	35	(a) self-care;
36	36	(b) engaging in family relationships;
37	37	(c) functioning in school; or
38	38	(d) functioning in the community;
39	39	(ii) the disorder creates a risk that the
40	40	person will be removed from the person's home and placed in a more
41	41	restrictive environment, including in a facility or program
42	42	operated by the Department of Family and Protective Services or an
43	43	agency that is part of the juvenile justice system;
44	44	(iii) the disorder causes the person to:
45	45	(a) display psychotic features or
46	46	violent behavior; or
47	47	(b) pose a danger to the person's self
48	48	or others; or
49	49	(iv) the disorder results in the person
50	50	meeting state special education eligibility requirements for
51	51	emotional disturbance.
52	52	SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is
53	53	amended by adding Section 1355.0041 to read as follows:
54	54	Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL
55	55	DISTURBANCE OF A CHILD. (a) 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	(b) 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 (a)(1)(B); and
73	73	(2) must provide coverage for an outpatient visit
74	74	described by Subsection (a)(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	(c) 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	(d) Not later than December 1, 2026, 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 (c), together with any recommendations for
88	88	legislation.
89	89	(e) This subsection and Subsections (c) and (d) expire
90	90	September 1, 2027.
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, 2026. A group health
120	120	benefit plan that is delivered, issued for delivery, or renewed
121	121	before January 1, 2026, 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, 2025.