Bill not drafted by TLC or Senate E&E.
Line and page numbers may not match official copy.
By Coleman H.B. No. 2774
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage by certain health benefit plans for children
1-3 with serious emotional disturbances.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 3.51-14, Insurance Code, is amended to
1-6 read as follows:
1-7 Art. 3.51-14. Mandatory Provision of Benefits for Certain
1-8 Serious Mental Illnesses
1-9 Sec. 1. DEFINITIONS [DEFINITION]. For purposes of this
1-10 article:[,]
1-11 (1) Children with serious emotional disturbances are
1-12 persons, from birth to 18 years of age, who currently or at any
1-13 time during the past year have had a diagnosable mental,
1-14 behavioral, or emotional disorder of sufficient duration to meet
1-15 diagnostic criteria specified within DSM-III-R, that resulted in
1-16 functional impairment which substantially interferes with or limits
1-17 the child's role or functioning in family, school, or community.
1-18 (2) "Health benefit plan" means a plan described by
1-19 Section 2 of this article.
1-20 Sec. 2. SCOPE OF ARTICLE [MANDATORY COVERAGE; EXEMPTION].
1-21 (a) This article applies only to a health benefit plan that
1-22 provides benefits for medical or surgical expenses incurred as a
1-23 result of a health condition, accident, or sickness, including:
1-24 (1) an individual, group, blanket, or franchise
2-1 insurance policy or insurance agreement, a group hospital service
2-2 contract, or an individual or group evidence of coverage that is
2-3 offered by:
2-4 (A) an insurance company;
2-5 (B) a group [Each insurer, nonprofit] hospital
2-6 service [plan] corporation operating under [subject to] Chapter 20
2-7 of this code;
2-8 (C) a[,] health maintenance organization
2-9 operating under [subject to] the Texas Health Maintenance
2-10 Organization Act (Chapter 20A, Vernon's Texas Insurance Code);
2-11 (D) a fraternal benefit society operating under
2-12 Chapter 10 of this code; or
2-13 (E) a stipulated premium insurance company
2-14 operating under Chapter 22 of this code; and
2-15 (2) to the extent permitted by the Employee Retirement
2-16 Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a
2-17 health benefit plan that is offered by:
2-18 (A) a multiple employer welfare arrangement as
2-19 defined by Section 3, Employee Retirement Income Security Act of
2-20 1974 (29 U.S.C. Section 1002); or
2-21 (B) another analogous benefit arrangement [,
2-22 employer, multiple employer, union, association, trustee, or other
2-23 self-funded or self-insured welfare or benefit plan, program, or
2-24 arrangement that issues group health insurance policies, enters
2-25 into health care service contracts or plans, or provides for group
2-26 health benefits, coverage, or services in this state for hospital,
2-27 medical, or surgical expenses incurred as a result of accident or
2-28 sickness shall offer and make available to each group policyholder,
2-29 contract holder, employer, multiple employer, union, association,
2-30 or trustee under a group policy, contract, plan, program, or
3-1 arrangement that provides hospital, surgical, and medical benefits,
3-2 coverage for services and benefits on an expense-incurred, service,
3-3 or prepaid basis for expenses incurred for the necessary care,
3-4 diagnosis, and treatment of serious mental illnesses].
3-5 (b) This article [section] does not apply to coverage under:
3-6 (1) a blanket accident and health insurance policy as
3-7 that term is defined under Section 2, Article 3.51-6 of this code;
3-8 (2) a short-term travel policy;
3-9 (3) an accident-only policy;
3-10 (4) a limited or specified-disease policy; or
3-11 (5) a medicare supplement policy, as that term is
3-12 defined under Section 1(3), Article 3.74 of this code.
3-13 Sec. 3. MENTAL HEALTH [LEVEL OF] COVERAGE. A health benefit
3-14 plan must provide coverage for the medical treatment of serious
3-15 mental illness under the same terms and conditions as coverage is
3-16 provided for other illnesses. The coverage offered under this
3-17 article [for services and benefits for the condition of serious
3-18 mental illness must be at least as favorable as the coverage made
3-19 available for services and benefits provided by the insuring entity
3-20 for other major illnesses and] must include the same durational
3-21 limits, amount limits, deductibles, and coinsurance factors for
3-22 serious mental illness as for other illnesses.
3-23 SECTION 2. This Act takes effect September 1, 1997, and
3-24 applies only to a health benefit plan that is delivered, issued for
3-25 delivery, or renewed on or after January 1, 1998. A health benefit
3-26 plan that is delivered, issued for delivery, or renewed before
3-27 January 1, 1998, is governed by the law as it existed immediately
3-28 before the effective date of this Act, and that law is continued in
3-29 effect for that purpose.
3-30 SECTION 3. The importance of this legislation and the
4-1 crowded condition of the calendars in both houses create an
4-2 emergency and an imperative public necessity that the
4-3 constitutional rule requiring bills to be read on three several
4-4 days in each house be suspended, and this rule is hereby suspended.