By Van de Putte H.B. No. 1750
76R6571 DB-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to certain mental health services provided under a health
1-3 benefit plan.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53S to read as follows:
1-7 Art. 21.53S. RESTRICTIONS APPLICABLE TO CERTAIN MENTAL
1-8 HEALTH SERVICES
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Enrollee" means an individual enrolled in a
1-11 health benefit plan.
1-12 (2) "Health benefit plan" means a plan described by
1-13 Section 2(a) of this article.
1-14 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-15 a health benefit plan that provides benefits for medical or
1-16 surgical expenses incurred as a result of a health condition,
1-17 accident, or sickness, including an individual, group, blanket, or
1-18 franchise insurance policy or insurance agreement, a group hospital
1-19 service contract, or an individual or group evidence of coverage or
1-20 similar coverage document that is offered by:
1-21 (1) an insurance company;
1-22 (2) a group hospital service corporation operating
1-23 under Chapter 20 of this code;
1-24 (3) a fraternal benefit society operating under
2-1 Chapter 10 of this code;
2-2 (4) a stipulated premium insurance company operating
2-3 under Chapter 22 of this code;
2-4 (5) a reciprocal exchange operating under Chapter 19
2-5 of this code;
2-6 (6) a health maintenance organization operating under
2-7 the Texas Health Maintenance Organization Act (Chapter 20A,
2-8 Vernon's Texas Insurance Code);
2-9 (7) a multiple employer welfare arrangement that holds
2-10 a certificate of authority under Article 3.95-2 of this code; or
2-11 (8) an approved nonprofit health corporation that
2-12 holds a certificate of authority issued by the commissioner under
2-13 Article 21.52F of this code.
2-14 (b) This article does not apply to:
2-15 (1) a plan that provides coverage:
2-16 (A) only for a specified disease or other
2-17 limited benefit;
2-18 (B) only for accidental death or dismemberment;
2-19 (C) for wages or payments in lieu of wages for a
2-20 period during which an employee is absent from work because of
2-21 sickness or injury;
2-22 (D) as a supplement to liability insurance;
2-23 (E) for credit insurance;
2-24 (F) only for dental or vision care;
2-25 (G) only for hospital expenses; or
2-26 (H) only for indemnity for hospital confinement;
2-27 (2) a small employer health benefit plan written under
3-1 Chapter 26 of this code;
3-2 (3) a Medicare supplemental policy as defined by
3-3 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-4 as amended;
3-5 (4) workers' compensation insurance coverage;
3-6 (5) medical payment insurance coverage issued as part
3-7 of a motor vehicle insurance policy; or
3-8 (6) a long-term care policy, including a nursing home
3-9 fixed indemnity policy, unless the commissioner determines that the
3-10 policy provides benefit coverage so comprehensive that the policy
3-11 is a health benefit plan as described by Subsection (a) of this
3-12 section.
3-13 Sec. 3. CERTAIN REQUIREMENTS RELATING TO MENTAL HEALTH
3-14 SERVICES PROHIBITED. The issuer of a health benefit plan may not:
3-15 (1) require, as a condition of coverage or for any
3-16 other reason, that:
3-17 (A) the provision of mental health services,
3-18 including services provided in a psychotherapy session, involving
3-19 an enrollee be observed by a representative of the issuer of the
3-20 health benefit plan; or
3-21 (B) a mental health care provider's process or
3-22 progress notes be submitted to the issuer of the health benefit
3-23 plan for review;
3-24 (2) deny benefits for mental health services,
3-25 including services provided in a psychotherapy session, on the
3-26 grounds that the enrollee refuses medication; or
3-27 (3) deny benefits for mental health services on the
4-1 grounds that the services are provided in a group session with
4-2 family members or other individuals.
4-3 Sec. 4. RULES. The commissioner may adopt rules as
4-4 necessary to implement this article.
4-5 SECTION 2. This Act applies only to a health benefit plan
4-6 that is delivered, issued for delivery, or renewed on or after the
4-7 effective date of this Act. A health benefit plan that is
4-8 delivered, issued for delivery, or renewed before the effective
4-9 date of this Act is governed by the law as it existed immediately
4-10 before the effective date of this Act, and that law is continued in
4-11 effect for that purpose.
4-12 SECTION 3. The importance of this legislation and the
4-13 crowded condition of the calendars in both houses create an
4-14 emergency and an imperative public necessity that the
4-15 constitutional rule requiring bills to be read on three several
4-16 days in each house be suspended, and this rule is hereby suspended,
4-17 and that this Act take effect and be in force from and after its
4-18 passage, and it is so enacted.