Bill Text: TX HB1511 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to required coverage for eating disorders under group health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-04-16 - Left pending in committee [HB1511 Detail]
Download: Texas-2019-HB1511-Introduced.html
| 86R8537 MEW-F | ||
| By: Coleman | H.B. No. 1511 | |
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| relating to required coverage for eating disorders under group | ||
| health benefit plans. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Section 1355.001, Insurance Code, is amended by | ||
| adding Subdivision (5) to read as follows: | ||
| (5) "Eating disorder" means: | ||
| (A) any eating disorder described by the | ||
| Diagnostic and Statistical Manual of Mental Disorders, fifth | ||
| edition, or a later edition adopted by the commissioner by rule, | ||
| including: | ||
| (i) anorexia nervosa; | ||
| (ii) bulimia nervosa; | ||
| (iii) binge eating disorder; | ||
| (iv) rumination disorder; | ||
| (v) avoidant/restrictive food intake | ||
| disorder; or | ||
| (vi) any eating disorder not otherwise | ||
| specified; or | ||
| (B) any eating disorder contained in a subsequent | ||
| edition of the Diagnostic and Statistical Manual of Mental | ||
| Disorders published by the American Psychiatric Association and | ||
| adopted by the commissioner by rule. | ||
| SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is | ||
| amended by adding Section 1355.008 to read as follows: | ||
| Sec. 1355.008. REQUIRED COVERAGE FOR EATING DISORDERS. (a) | ||
| A group health benefit plan must provide coverage, based on medical | ||
| necessity, for the diagnosis and treatment of an eating disorder. | ||
| (b) Coverage required under Subsection (a) is limited to a | ||
| service or medication, to the extent the service or medication is | ||
| covered by the group health benefit plan, ordered by a licensed | ||
| physician, psychiatrist, psychologist, or therapist within the | ||
| scope of the practitioner's license and in accordance with a | ||
| treatment plan. | ||
| (c) On request from the group health benefit plan issuer, an | ||
| eating disorder treatment plan must include all elements necessary | ||
| for the issuer to pay a claim under the group health benefit plan, | ||
| which may include a diagnosis, goals, and proposed treatment by | ||
| type, frequency, and duration. | ||
| (d) Coverage required under Subsection (a) is not subject to | ||
| a limit on the number of days of medically necessary treatment | ||
| except as provided by the treatment plan. | ||
| (e) A group health benefit plan issuer may conduct a | ||
| utilization review of an eating disorder treatment plan not more | ||
| than once each six months unless the physician, psychiatrist, | ||
| psychologist, or therapist treating the enrollee under the | ||
| treatment plan agrees that a more frequent review is necessary. An | ||
| agreement to conduct more frequent reviews under this subsection | ||
| applies only to the enrollee who is the subject of the agreement. | ||
| (f) A group health benefit plan issuer shall pay any costs | ||
| of conducting a utilization review of coverage required under | ||
| Subsection (a) or obtaining a treatment plan. | ||
| (g) In conducting a utilization review of treatment for an | ||
| eating disorder, including review of medical necessity or the | ||
| treatment plan, a utilization review agent shall consider: | ||
| (1) the overall medical and mental health needs of the | ||
| individual with the eating disorder; | ||
| (2) factors in addition to weight; and | ||
| (3) the most recent Practice Guideline for the | ||
| Treatment of Patients with Eating Disorders adopted by the American | ||
| Psychiatric Association. | ||
| SECTION 3. The changes in law made by this Act apply only to | ||
| a group health benefit plan delivered, issued for delivery, or | ||
| renewed on or after January 1, 2020. | ||
| SECTION 4. This Act takes effect September 1, 2019. | ||
