79R3771 AJA-D

By:  Eissler                                                      H.B. No. 712



A BILL TO BE ENTITLED

AN ACT

relating to coverage for certain mental disorders in children under 
a health coverage plan established by the Teacher Retirement System 
of Texas under the Texas School Employees Uniform Group Health 
Coverage Act.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter C, Chapter 1579, Insurance Code, is 
amended by adding Section 1579.109 to read as follows:
	Sec. 1579.109.  CERTAIN MENTAL DISORDERS IN CHILDREN.  (a)  
In this section:
		(1)  "Child" means a person younger than 19 years of 
age.            
		(2)  "Mental disorder" means a disorder that is 
identified in the Diagnostic and Statistical Manual of Mental 
Disorders, fourth edition, or in a subsequent edition of that 
manual that the commissioner by rule adopts to take the place of the 
fourth edition or any subsequent edition for the purposes of this 
subdivision and that results in a significant impairment of a 
child's functioning in the child's community, family, school, or 
peer group.  The term does not include a primary substance abuse 
disorder or a developmental disorder.
	(b)  A health coverage plan under this chapter must include 
coverage for an enrollee who is a child for the diagnosis and 
treatment of a mental disorder.  Except as provided by this section, 
coverage required under this subsection must be provided under the 
same terms and conditions as coverage for diagnosis and treatment 
of physical illness.
	(c)  Coverage required under this section may be provided or 
offered through a managed care plan.
	(d)  Except as provided by this subsection, the health 
coverage plan must cover inpatient stays and outpatient visits 
under this section under the same terms and conditions as the plan 
covers inpatient stays and outpatient visits for treatment of a 
physical illness.  Coverage required by this section may not be 
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.
	(e)  Coverage provided under this section must be subject to 
the same amount limits, deductibles, copayments, and coinsurance 
factors as coverage for physical illness.
	(f)  The trustee shall adopt rules as necessary to implement 
this section.
	SECTION 2.  (a)  On or before September 1, 2010, the Sunset 
Advisory Commission shall conduct a study to determine:
		(1)  to what extent the health benefit plan coverage 
required by Section 1579.109, Insurance Code, as added by this Act, 
is being used by enrollees in health coverage plans to which that 
section applies; and
		(2)  the impact of the required coverage on the cost of 
those health coverage plans.
	(b)  The Sunset Advisory Commission shall report its 
findings under this section to the legislature on or before January 
1, 2011.
	(c)  The Teacher Retirement System of Texas, the Texas 
Department of Insurance, and any other state agency shall cooperate 
with the Sunset Advisory Commission as necessary to implement this 
section.
	SECTION 3.  This Act applies only to group health coverage 
under Chapter 1579, Insurance Code, as amended by this Act, on or 
after September 1, 2005.
	SECTION 4.  This Act takes effect September 1, 2005.