RS C.S.H.B. 1173 75(R)    BILL ANALYSIS

C.S.H.B. 1173
By: Coleman
Committee Report (Substituted)


Persons with serious mental illness - despite having group health
insurance- are often unable to obtain adequate mental health care because
of severe restrictions or limits in coverage for mental health treatment.
Insurance companies have historically operated under the mistaken
assumption that no causal links can be determined between physical
findings and mental illness.  If insurance companies propose to operate
under the premise that they should not provide coverage for diseases for
which there are no established scientifically causes, then there are many
conditions, such as idiopathic cardiomyopathy, that should also be denied
coverage.  The fact is, science is not exact and there are many widely
recognized diseases that are poorly understood.  Inadequate coverage for
mental health treatment leads to poor quality care and shifts the costs to
limited public mental health resources.  Improving insurance coverage for
persons with serious mental illness requires greater access to treatment.
Mental illnesses are medical illnesses, just like cancer, diabetes, or
cardiovascular disease, and people who suffer from them should have the
same access to benefits and care. 


House Bill 1173 amends the Insurance Code to require delivery or issuance
of group health insurance policies that provide a maximum number of
inpatient treatment days and outpatient visits for serious mental illness.
Coverage for these treatment days must be equal to the same terms and
conditions that apply to the benefits available for other illness. 


It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency or


SECTION 1.  Amends Article 3.51-14 of the Insurance Code, as follows:

Sec. 1.  Definitions. Defines "serious mental illnesses," "group health
benefit plan," and "small employer." 

Sec. 2.  New title: SCOPE OF ARTICLE.  Sets forth the applicability of the
article to group health benefit plans. 

Requires group health benefit plans to provide coverage, in each calendar
year, for 45 days of inpatient treatment and 60 visits for outpatient
treatment for serious mental illness, and prohibits lifetime limits for
such treatment.  Requires that the coverage for these treatment days and
visits include the same amount limits, deductibles, and coinsurance
factors as for physical illnesses. 

b) Disallows an issuer of group plans from counting toward the number of
outpatient visits any visit necessary for medication management. 

(c) Allows an issuer of a group plan to offer coverage through a managed
care plan. 

 Sec. 4. SMALL EMPLOYER COVERAGE.  Requires an issuer of a group plan to a
small employer to offer the coverage described in Section 3. 

SECTION 2.  Effective date.

SECTION 3. Emergency clause.


Section 1.
Sec. 1. Definitions.  This section redefines "serious mental illness" by
deleting (g) through (k) and changing (f) from "obsessive-compulsive"
disorders to "psychiatric illness" experienced by a child that
substantially interferes with a child's ability to function in his or her
community, family, or school. The purpose for this change is to allow for
more effective treatment of children's  mental illnesses.  Additionally,
"health benefit plan" was changed to "group health benefit plan."A
definition for "small employer" was added. 

Sec. 2. Scope of Article.  The article was changed to apply only to group
health benefit plans rather than individual health benefit plans, blanket
and franchise plans. 

Sec. 3. Required Coverage for Serious Mental Illnesses.  The substitute
changes required  coverage from full parity to maximum required inpatient
stays and outpatient treatment days.  Adds a provision that outpatient
visits for medication management will not be counted toward the number of
outpatient visits required to be covered.  Adds a provision that a managed
care  plan may be used to offer coverage.   

Sec. 4. Small Employer Coverage.  Provides that a mandated offer must be
made by an issuer of a group health benefit plan to a small employer.