1-1 AN ACT
1-2 relating to application of certain coverage requirements for
1-3 serious mental illness.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 3(a)(19), Texas Employees Uniform Group
1-6 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
1-7 Code), as added by Section 11.106, Chapter 242, Acts of the 72nd
1-8 Legislature, Regular Session, 1991, is redesignated as Section
1-9 3(a)(23), Texas Employees Uniform Group Insurance Benefits Act
1-10 (Article 3.50-2, Vernon's Texas Insurance Code), and amended to
1-11 read as follows:
1-12 (23) "Serious [(19) For the purposes of this section,
1-13 "serious] mental illness" has the meaning assigned by Section 1,
1-14 Article 3.51-14, Insurance Code [means the following psychiatric
1-15 illnesses as defined by the American Psychiatric Association in the
1-16 Diagnostic and Statistical Manual (DSM) III-R:]
1-17 [(A) schizophrenia;]
1-18 [(B) paranoid and other psychotic disorders;]
1-19 [(C) bipolar disorders (mixed, manic, and
1-20 depressive);]
1-21 [(D) major depressive disorders (single episode
1-22 or recurrent); and]
1-23 [(E) schizo-affective disorders (bipolar or
1-24 depressive)].
2-1 SECTION 2. Section 3(a)(16), Texas State College and
2-2 University Employees Uniform Insurance Benefits Act (Article
2-3 3.50-3, Vernon's Texas Insurance Code), as added by Section 11.108,
2-4 Chapter 242, Acts of the 72nd Legislature, Regular Session, 1991,
2-5 is redesignated as Section 3(a)(19), Texas State College and
2-6 University Employees Uniform Insurance Benefits Act (Article
2-7 3.50-3, Vernon's Texas Insurance Code), and amended to read as
2-8 follows:
2-9 (19) "Serious [(16) For purposes of this section,
2-10 "serious] mental illness" has the meaning assigned by Section 1,
2-11 Article 3.51-14, Insurance Code [means the following psychiatric
2-12 illnesses as defined by the American Psychiatric Association in the
2-13 Diagnostic and Statistical Manual (DSM) III-R:]
2-14 [(A) schizophrenia;]
2-15 [(B) paranoid and other psychotic disorders;]
2-16 [(C) bipolar disorders (mixed, manic, and
2-17 depressive);]
2-18 [(D) major depressive disorders (single episode
2-19 or recurrent); and]
2-20 [(E) schizo-affective disorders (bipolar or
2-21 depressive)].
2-22 SECTION 3. Article 3.51-5A(b), Insurance Code, is amended to
2-23 read as follows:
2-24 (b) For purposes of this article, "serious mental illness"
2-25 has the meaning assigned by Section 1, Article 3.51-14, of this
2-26 code [means the following psychiatric illnesses as defined by the
2-27 American Psychiatric Association in the Diagnostic and Statistical
3-1 Manual (DSM) III-R:]
3-2 [(1) schizophrenia;]
3-3 [(2) paranoid and other psychotic disorders;]
3-4 [(3) bipolar disorders (mixed, manic, and depressive);]
3-5 [(4) major depressive disorders (single episode or
3-6 recurrent); and]
3-7 [(5) schizo-affective disorders (bipolar or
3-8 depressive)].
3-9 SECTION 4. Section 2(b), Article 3.51-14, Insurance Code, is
3-10 amended to read as follows:
3-11 (b) This article does not apply to coverage under:
3-12 (1) a blanket accident and health insurance policy as
3-13 that term is defined under Section 2, Article 3.51-6, of this code;
3-14 (2) a short-term travel policy;
3-15 (3) an accident-only policy;
3-16 (4) a limited or specified-disease policy, other than
3-17 a plan that provides benefits for mental health care or similar
3-18 services; [or]
3-19 (5) with the exception of Section 1 of this article
3-20 which shall apply, a plan offered under the Texas Employees Uniform
3-21 Group Insurance Benefits Act (Article 3.50-2, Vernon's Texas
3-22 Insurance Code) or the Texas State College and University Employees
3-23 Uniform Insurance Benefits Act (Article 3.50-3, Vernon's Texas
3-24 Insurance Code);
3-25 (6) a plan offered under or in accordance with Article
3-26 3.51-5A of this code; or
3-27 (7) a medicare supplement policy, as that term is
4-1 defined under Section 1(b)(3) [1(3)], Article 3.74, of this code.
4-2 SECTION 5. Section 3(a), Article 3.51-14, Insurance Code, is
4-3 amended to read as follows:
4-4 (a) Except as provided by Section 4 of this article, a group
4-5 health benefit plan:
4-6 (1) must provide coverage, based on medical necessity,
4-7 for the following treatment of serious mental illness in each
4-8 calendar year:
4-9 (A) 45 days of inpatient treatment; and
4-10 (B) 60 visits for outpatient treatment,
4-11 including group and individual outpatient treatment;
4-12 (2) may not include a lifetime limit on the number of
4-13 days of inpatient treatment or the number of outpatient visits
4-14 covered under the plan; and
4-15 (3) must include the same amount limits, deductibles,
4-16 copayments, and coinsurance factors for serious mental illness as
4-17 for physical illness.
4-18 SECTION 6. This Act takes effect September 1, 1999, and
4-19 applies only to a health benefit plan that is delivered, issued for
4-20 delivery, or renewed on or after January 1, 2000. A health benefit
4-21 plan that is delivered, issued for delivery, or renewed before
4-22 January 1, 2000, is governed by the law as it existed immediately
4-23 before the effective date of this Act, and that law is continued in
4-24 effect for this purpose.
4-25 SECTION 7. The importance of this legislation and the
4-26 crowded condition of the calendars in both houses create an
4-27 emergency and an imperative public necessity that the
5-1 constitutional rule requiring bills to be read on three several
5-2 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2424 was passed by the House on May
4, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 2424 on May 22, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 2424 was passed by the Senate, with
amendments, on May 20, 1999, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor