HBA-ATS H.B. 1750 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1750 By: Van de Putte Insurance 3/16/1999 Introduced BACKGROUND AND PURPOSE Many insurers use utilization review agents to determine whether they should pay for health care services provided to, or requested by, a consumer. In 1997, the Texas Department of Insurance adopted a rule that prohibits a licensed utilization review agent from requiring, as a condition of treatment approval, or for any other reason, the observation of a psychotherapy session or the submission or review of a mental health therapist's process or progress notes. The rule does not encompass insurance companies and health maintenance organizations. H.B. 1750 prohibits an insurer from requiring, as a condition of coverage or for any other reason, the observation of mental health services, including services provided in a psychotherapy session, by a representative of the insurer, or the submission, for review, of a mental health care provider's process or progress notes to an insurer. This bill also prohibits an insurer from denying benefits for mental health services, including services provided in a psychotherapy session, on the grounds that the enrollee refuses medication. In addition, this bill prohibits an insurer from denying benefits for mental health services on the grounds that the services are provided in a group session with family members or other individuals. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of insurance in SECTION 1 (Article 21.53S, Insurance Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53S, as follows: Art. 21.53S. RESTRICTIONS APPLICABLE TO CERTAIN MENTAL HEALTH SERVICES Sec. 1. DEFINITIONS. Defines "enrollee" and "health benefit plan." Sec. 2. SCOPE OF ARTICLE. (a) Specifies that Article 21.53S applies only to a comprehensive health benefit plan that provides benefits for medical or surgical expenses incurred because of a health condition, accident, or sickness. These types of plans include an individual, group, blanket, or franchise insurance policy or insurance agreement, and a group hospital service contract. Also included is individual or group coverage offered by an insurance company; a group hospital service corporation; a fraternal benefit society; a stipulated premium insurance company; a reciprocal exchange; a health maintenance organization; a multiple employer welfare arrangement; or an approved nonprofit health corporation. (b) Provides that Article 21.53S does not apply to a plan that provides coverage only for a specific disease or other limited benefit; only for accidental death or dismemberment; for wages or payments for a period during which an employee is absent from work because of sickness or injury; as a supplement to liability insurance; for credit insurance; only for dental or vision care; only for hospital expenses; or only for indemnity for hospital confinement. Also excluded is a small employer health benefit plan; a Medicare supplemental policy; workers' compensation insurance coverage; medical payment insurance coverage issued as part of a motor vehicle insurance policy; or a long-term care policy. Sec. 3. CERTAIN REQUIREMENTS RELATING TO MENTAL HEALTH SERVICES PROHIBITED. Prohibits an insurer from requiring, as a condition of coverage or for any other reason, the observation of mental health services, including services provided in a psychotherapy session, by a representative of the insurer, or the submission, for review, of a mental health care provider's process or progress notes to an insurer. Prohibits an insurer from denying benefits for mental health services, including services provided in a psychotherapy session, on the grounds that the enrollee refuses medication. Prohibits an insurer from denying benefits for mental health services on the grounds that the services are provided in a group session with family members or other individuals. Sec. 4. RULES. Authorizes the commissioner of insurance to adopt rules as necessary to administer this article. SECTION 2. Makes application of this Act prospective for health benefit plans that are delivered, issued for delivery, or renewed on or after the effective date of this Act. SECTION 3.Emergency clause. Effective date: upon passage.