Bill Text: TX SB2218 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to coverage for serious mental illness, other disorders, and chemical dependency under certain health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-21 - Referred to Business & Commerce [SB2218 Detail]
Download: Texas-2019-SB2218-Introduced.html
By: Zaffirini | S.B. No. 2218 | |
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relating to coverage for serious mental illness, other disorders, | ||
and chemical dependency under certain health benefit plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. The heading to Subchapter A, Chapter 1355, | ||
Insurance Code, is amended to read as follows: | ||
SUBCHAPTER A. [ |
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SERIOUS MENTAL ILLNESSES AND OTHER DISORDERS | ||
SECTION 2. Section 1355.002, Insurance Code, is amended by | ||
amending Subsection (a) and adding Subsections (c) and (d) to read | ||
as follows: | ||
(a) This subchapter applies only to a [ |
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plan that provides benefits for medical or surgical expenses | ||
incurred as a result of a health condition, accident, or sickness, | ||
including: | ||
(1) an individual, [ |
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insurance policy or [ |
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service contract, [ |
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or a similar coverage document, that is offered by: | ||
(A) an insurance company; | ||
(B) a group hospital service corporation | ||
operating under Chapter 842; | ||
(C) a fraternal benefit society operating under | ||
Chapter 885; | ||
(D) a stipulated premium company operating under | ||
Chapter 884; [ |
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(E) a health maintenance organization operating | ||
under Chapter 843; [ |
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(F) an exchange operating under Chapter 942; | ||
(G) a Lloyd's plan operating under Chapter 941; | ||
(H) an approved nonprofit health corporation | ||
that holds a certificate of authority under Chapter 844; or | ||
(I) a multiple employer welfare arrangement that | ||
holds a certificate of authority under Chapter 846; and | ||
(2) to the extent permitted by the Employee Retirement | ||
Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a plan | ||
offered under: | ||
(A) a multiple employer welfare arrangement as | ||
defined by Section 3 of that Act; or | ||
(B) another analogous benefit arrangement. | ||
(c) Notwithstanding any other law, this subchapter applies | ||
to: | ||
(1) a small employer health benefit plan subject to | ||
Chapter 1501, including coverage provided through a health group | ||
cooperative under Subchapter B of that chapter; and | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507. | ||
SECTION 3. The heading to Section 1355.003, Insurance Code, | ||
is amended to read as follows: | ||
Sec. 1355.003. EXCEPTIONS [ |
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SECTION 4. Section 1355.003, Insurance Code, is amended by | ||
amending Subsection (a) and adding Subsection (c) to read as | ||
follows: | ||
(a) This subchapter does not apply to coverage under: | ||
(1) [ |
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[ |
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(2) [ |
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(3) [ |
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does not provide benefits for mental health care or similar | ||
services; | ||
(4) [ |
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offered under Chapter 1551 or Chapter 1601; | ||
(5) [ |
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1355.151; or | ||
(6) [ |
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defined by Section 1652.002. | ||
(c) To the extent that this section would otherwise require | ||
this state to make a payment under 42 U.S.C. Section | ||
18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 | ||
C.F.R. Section 155.20, is not required to provide a benefit under | ||
this subchapter that exceeds the specified essential health | ||
benefits required under 42 U.S.C. Section 18022(b). | ||
SECTION 5. Section 1355.004, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL | ||
ILLNESS. (a) A [ |
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(1) must provide coverage, based on medical necessity, | ||
for not less than the following treatments of serious mental | ||
illness in each calendar year: | ||
(A) 45 days of inpatient treatment; and | ||
(B) 60 visits for outpatient treatment, | ||
including group and individual outpatient treatment; | ||
(2) may not include a lifetime limitation on the | ||
number of days of inpatient treatment or the number of visits for | ||
outpatient treatment covered under the plan; and | ||
(3) must include the same amount limitations, | ||
deductibles, copayments, and coinsurance factors for serious | ||
mental illness as the plan includes for physical illness. | ||
(b) A [ |
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(1) may not count an outpatient visit for medication | ||
management against the number of outpatient visits required to be | ||
covered under Subsection (a)(1)(B); and | ||
(2) must provide coverage for an outpatient visit | ||
described by Subsection (a)(1)(B) under the same terms as the | ||
coverage the issuer provides for an outpatient visit for the | ||
treatment of physical illness. | ||
SECTION 6. Section 1355.005, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A [ |
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health benefit plan issuer may provide or offer coverage required | ||
by Section 1355.004 through a managed care plan. | ||
SECTION 7. Section 1355.006(b), Insurance Code, is amended | ||
to read as follows: | ||
(b) This subchapter does not require a [ |
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benefit plan to provide coverage for the treatment of: | ||
(1) addiction to a controlled substance or marihuana | ||
that is used in violation of law; or | ||
(2) mental illness that results from the use of a | ||
controlled substance or marihuana in violation of law. | ||
SECTION 8. Section 1368.002, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1368.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
applies only to a [ |
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hospital and medical coverage or services on an expense incurred, | ||
service, or prepaid basis, including an individual, [ |
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blanket, or franchise insurance policy or insurance agreement, a | ||
group hospital service contract, an individual or group evidence of | ||
coverage, or a similar coverage document, or a self-funded or | ||
self-insured plan or arrangement, that is offered in this state by: | ||
(1) an insurer; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a health maintenance organization operating under | ||
Chapter 843; [ |
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(4) an employer, trustee, or other self-funded or | ||
self-insured plan or arrangement; | ||
(5) a fraternal benefit society operating under | ||
Chapter 885; | ||
(6) a stipulated premium company operating under | ||
Chapter 884; | ||
(7) an exchange operating under Chapter 942; | ||
(8) a Lloyd's plan operating under Chapter 941; | ||
(9) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844; or | ||
(10) a multiple employer welfare arrangement that | ||
holds a certificate of authority under Chapter 846. | ||
(b) Notwithstanding any other law, this chapter applies to: | ||
(1) a small employer health benefit plan subject to | ||
Chapter 1501, including coverage provided through a health group | ||
cooperative under Subchapter B of that chapter; and | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507. | ||
SECTION 9. Section 1368.003, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1368.003. EXCEPTIONS [ |
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does not apply to: | ||
(1) an employer, trustee, or other self-funded or | ||
self-insured plan or arrangement with 250 or fewer employees or | ||
members; | ||
(2) [ |
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[ |
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[ |
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(A) cash indemnity for hospital or other | ||
confinement benefits; | ||
(B) supplemental or limited benefit coverage; | ||
(C) coverage for specified diseases or | ||
accidents; | ||
(D) disability income coverage; or | ||
(E) any combination of those benefits or | ||
coverages; | ||
(3) [ |
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[ |
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(4) [ |
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(5) [ |
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policy; | ||
(6) [ |
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[ |
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person eligible for Medicare coverage or other similar coverage | ||
under a state or federal government plan; or | ||
(7) [ |
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health maintenance organization if the plan holder is the subject | ||
of a collective bargaining agreement that was in effect on January | ||
1, 1982, and that has not expired since that date. | ||
(b) To the extent that this section would otherwise require | ||
this state to make a payment under 42 U.S.C. Section | ||
18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 | ||
C.F.R. Section 155.20, is not required to provide a benefit under | ||
this chapter that exceeds the specified essential health benefits | ||
required under 42 U.S.C. Section 18022(b). | ||
SECTION 10. Section 1368.004, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1368.004. COVERAGE REQUIRED. (a) A [ |
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benefit plan shall provide coverage for the necessary care and | ||
treatment of chemical dependency. | ||
(b) Coverage required under this section may be provided: | ||
(1) directly by the [ |
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issuer; or | ||
(2) by another entity, including a single service | ||
health maintenance organization, under contract with the [ |
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health benefit plan issuer. | ||
SECTION 11. Section 1368.005(b), Insurance Code, is amended | ||
to read as follows: | ||
(b) A [ |
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durational limits for coverage required under this chapter that are | ||
less favorable than for coverage provided for physical illness | ||
generally under the plan if those limits are sufficient to provide | ||
appropriate care and treatment under the guidelines and standards | ||
adopted under Section 1368.007. If guidelines and standards | ||
adopted under Section 1368.007 are not in effect, the dollar and | ||
durational limits may not be less favorable than for physical | ||
illness generally. | ||
SECTION 12. Section 1355.007, Insurance Code, is repealed. | ||
SECTION 13. The changes in law made by this Act apply only | ||
to a health benefit plan that is delivered, issued for delivery, or | ||
renewed on or after January 1, 2020. A health benefit plan that is | ||
delivered, issued for delivery, or renewed before January 1, 2020, | ||
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 14. This Act takes effect September 1, 2019. |