By: Johnson S.B. No. 636
(In the Senate - Filed December 18, 2024; February 3, 2025,
read first time and referred to Committee on Health & Human
Services; April 14, 2025, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 7, Nays 2;
April 14, 2025, sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR S.B. No. 636 By: Hancock
A BILL TO BE ENTITLED
AN ACT
relating to coverage for mental health conditions and substance use
disorders under certain governmental health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.002(b), Insurance Code, is amended
to read as follows:
(b) Except as otherwise provided by this subchapter, but
notwithstanding [Notwithstanding any provision in Chapter 1575 or
1579 or] any other law, this subchapter [Section 1355.015] applies
to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575; [and]
(3) [(2)] a primary care coverage plan under Chapter
1579; and
(4) a plan providing basic coverage under Chapter
1601.
SECTION 2. Section 1355.003(a), Insurance Code, is amended
to read as follows:
(a) This subchapter does not apply to coverage under:
(1) a blanket accident and health insurance policy, as
described by Chapter 1251;
(2) a short-term travel policy;
(3) an accident-only policy;
(4) a limited or specified-disease policy that does
not provide benefits for mental health care or similar services;
(5) [except as provided by Subsection (b), a plan
offered under Chapter 1551 or Chapter 1601;
[(6)] a plan offered in accordance with Section
1355.151; or
(6) [(7)] a Medicare supplement benefit plan, as
defined by Section 1652.002.
SECTION 3. Section 1355.015(e), Insurance Code, is amended
to read as follows:
(e) Notwithstanding any other law, this section does not
apply to:
(1) a standard health benefit plan provided under
Chapter 1507;
(2) a basic coverage plan under Chapter 1551; or
(3) a plan providing basic coverage under Chapter
1601.
SECTION 4. Section 1355.252, Insurance Code, is amended by
adding Subsection (d) to read as follows:
(d) Notwithstanding any other law, this subchapter 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;
and
(4) a plan providing basic coverage under Chapter
1601.
SECTION 5. Section 1355.255, Insurance Code, is amended to
read as follows:
Sec. 1355.255. COMPLIANCE. (a) Except as provided by
Subsection (b), the [The] commissioner shall enforce compliance
with Section 1355.254 by evaluating the benefits and coverage
offered by a health benefit plan for quantitative and
nonquantitative treatment limitations in the following categories:
(1) in-network and out-of-network inpatient care;
(2) in-network and out-of-network outpatient care;
(3) emergency care; and
(4) prescription drugs.
(b) With respect to a plan described by Section 1355.252(d),
the applicable trustee, board of trustees, or system shall enforce
compliance with Section 1355.254 by evaluating the benefits and
coverage offered by a health benefit plan for quantitative and
nonquantitative treatment limitations in the following categories:
(1) in-network and out-of-network inpatient care;
(2) in-network and out-of-network outpatient care;
(3) emergency care; and
(4) prescription drugs.
SECTION 6. Section 1551.205, Insurance Code, is amended to
read as follows:
Sec. 1551.205. LIMITATIONS. The board of trustees may not
contract for or provide a coverage plan that:
(1) excludes or limits coverage or services for
acquired immune deficiency syndrome, as defined by the Centers for
Disease Control and Prevention of the United States Public Health
Service, or human immunodeficiency virus infection; or
(2) [provides coverage for serious mental illness that
is less extensive than the coverage provided for any physical
illness; or
[(3)] may provide coverage for prescription drugs to
assist in stopping smoking at a lower benefit level than is provided
for other prescription drugs.
SECTION 7. Section 1355.003(b), Insurance Code, is
repealed.
SECTION 8. The changes in law made by this Act apply only to
a plan year that commences on or after January 1, 2026. A plan year
that commenced before January 1, 2026, 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, 2025.
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