RS C.S.H.B. 1173 75(R) BILL ANALYSIS INSURANCE C.S.H.B. 1173 By: Coleman 4-21-97 Committee Report (Substituted) BACKGROUND 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. PURPOSE 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. RULEMAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency or institution. SECTION BY SECTION ANALYSIS 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. Sec. 3. New title: REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESSES. (a) 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. COMPARISON OF ORIGINAL TO SUBSTITUTE 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.