SRC-MWN S.B. 806 77(R)   BILL ANALYSIS


Senate Research Center   S.B. 806
77R4990 AJA-FBy: Van de Putte
Business & Commerce
2/28/2001
As Filed


DIGEST AND PURPOSE 

Currently, many private insurance policies do not cover children's mental
health illnesses at the same level of physical health care. As a result,
many mental illnesses in children are not treated and sometimes not even
discovered until the mental illness in a child causes a physical ailment.
As proposed, S.B. 806 directs insurance benefit plans to cover children's
mental health at the same level as physical health coverage. 

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the commissioner of insurance
in SECTION 1 (Section 6, Article 21.53R, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 21E, Insurance Code, by adding Article 21.53R, as
follows: 

 Art. 21.53R. COVERAGE FOR CERTAIN MENTAL DISORDERS IN CHILDREN

 Sec. 1. DEFINITIONS. Defines "child" and "mental disorder."

Sec. 2. APPLICABILITY OF ARTICLE. Provides that this article applies only
to a health benefit plan that provides benefits for medical or surgical
expenses incurred as a result of a health condition, accident, or sickness,
including an individual, group, blanket, or franchise insurance policy or
insurance agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage that is offered by certain
entities. Provides that this article applies to a small employer health
benefit plan written under Chapter 26 (Health Insurance Availability) of
this code. Provides that this article does not apply to a plan that
provides coverage for certain conditions; a Medicare supplemental policy as
defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section
1395ss), as amended; a workers' compensation insurance policy; medical
payment insurance coverage provided under a motor vehicle insurance policy;
or a long-term care insurance policy, including a nursing home fixed
indemnity policy, unless the commissioner of insurance (commissioner)
determines that the policy provides benefit coverage so comprehensive that
the policy is a health benefit plan as described by this section. 

Sec. 3. COVERAGE REQUIRED. Requires a health benefit plan to provide
coverage for an enrollee who is a child for the diagnosis and treatment of
a mental disorder. Requires a health benefit plan, except as provided by
this article, to provide coverage required under this subsection under the
same terms and conditions as coverage for diagnosis and treatment of
physical illness. Authorizes coverage required under this article to be
provided or offered through a managed care plan. 

Sec. 4. COVERAGE OF INPATIENT STAYS AND OUTPATIENT VISITS. Requires a
health benefit plan, except as provided by this section, to cover inpatient
stays and outpatient  visits under this article under the same terms and
conditions as the plan covers inpatient stays and outpatient visits for
treatment of a physical illness. Prohibits a coverage required by this
article from being subject to an annual or lifetime limit on the number of
days of inpatient treatment or the number of outpatient visits covered
under the plan. 

 Sec. 5. AMOUNT LIMITS; DEDUCTIBLES; COPAYMENTS; COINSURANCE. Requires
coverage provided under this article to be subject to the same amount
limits, deductibles, copayments, and coinsurance factors as coverage for
physical illness. 

Sec. 6. RULES. Requires the commissioner to adopt rules as necessary to
implement this article. 

SECTION 2. Amends Section 1(1), Article 3.51-14, Insurance Code, to delete
text regarding depression in childhood and adolescence in the definition of
"serious mental illness." Makes a conforming change. 

SECTION 3. Amends Section 3(a), Article 3.51-14, Insurance Code, to provide
that except as provided by Section 4 of this article or Article 21.53R of
this code, a group health benefit plan is required to meet certain
criteria. 

SECTION 4. Effective date: September 1, 2001.
                      Makes application of this Act prospective to January
1, 2002.