79R3911 KCR-D

By:  Rose                                                         H.B. No. 1669



A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for the diagnosis and 
treatment of eating disorders.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subtitle E, Title 8, Insurance Code, as 
effective April 1, 2005, is amended by adding Chapter 1371 to read 
as follows:
	CHAPTER  1371.  DIAGNOSIS AND TREATMENT OF EATING DISORDERS
	Sec. 1371.001.  DEFINITIONS.  In this subchapter, "eating 
disorder" means anorexia nervosa, bulimia nervosa, or an eating 
disorder not otherwise specified, as those terms are defined by the 
Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
	Sec. 1371.002.  APPLICABILITY OF CHAPTER.  (a) Except as 
provided by this section and notwithstanding any other law, this 
chapter applies only to a health benefit plan, including a small 
employer health benefit plan written under Chapter 1501 or coverage 
provided by a health group cooperative under Subchapter B of that 
chapter or Article 26.14A of this code, 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 document that is offered by:
		(1)  an insurance company;                                             
		(2)  a group hospital service corporation operating 
under Chapter 842;
		(3)  a fraternal benefit society operating under 
Chapter 885;        
		(4)  a stipulated premium company operating under 
Chapter 884;       
		(5)  a reciprocal exchange operating under Chapter 942;                
		(6)  a Lloyd's plan operating under Chapter 941;                       
		(7)  a health maintenance organization operating under 
Chapter 843;  
		(8)  a multiple employer welfare arrangement that holds 
a certificate of authority under Chapter 846; or
		(9)  an approved nonprofit health corporation that 
holds a certificate of authority under Chapter 844.
	(b)  Notwithstanding Section 172.014, Local Government Code, 
or any other law, this chapter applies to health and accident 
coverage provided by a risk pool created under Chapter 172, Local 
Government Code.
	(c)  Notwithstanding any provision in Chapter 1551, 1575, 
1579, or 1601 or any other law, this chapter applies to:
		(1)  a basic coverage plan under Chapter 1551;                         
		(2)  a basic plan under Chapter 1575;                                  
		(3)  a primary care coverage plan under Chapter 1579; 
and            
		(4)  basic coverage under Chapter 1601.                                
	(d)  Notwithstanding any other law, a standard health 
benefit plan provided under Chapter 1507 or Article 3.80 or 20A.09N 
of this code must provide the coverage required by this chapter.
	Sec. 1371.003.  REQUIRED COVERAGE FOR EATING DISORDERS.  (a)  
A health benefit plan must provide coverage for the diagnosis of 
eating disorders.
	(b)  A health benefit plan, based on medical necessity:                 
		(1)  must provide coverage for not less than the 
following treatments of eating disorders in each calendar year:
			(A)  60 days of inpatient treatment; and                              
			(B)  60 visits for outpatient treatment, 
including group and individual outpatient treatment;
		(2)  may not include a lifetime limitation on the 
number of days of inpatient treatment or the number of visits for 
outpatient treatment covered under the plan; and
		(3)  must include the same amount limitations, 
deductibles, copayments, and coinsurance factors for eating 
disorders as the plan includes for physical illness not related to 
an eating disorder and, if applicable, for serious mental illness.
	(c)  A health benefit plan issuer:                                      
		(1)  may not treat an outpatient visit for medication 
or weight management as an outpatient visit required to be covered 
under Subsection (b)(1)(B); and
		(2)  must provide coverage for an outpatient visit 
described by Subsection (b)(1)(B) under the same terms as the 
coverage the issuer provides for an outpatient visit for the 
treatment of physical illness not related to an eating disorder 
and, if applicable, for serious mental illness.
	Sec. 1371.004.  ACCESS TO PROVIDERS AND FACILITIES.  (a)  
Notwithstanding any other law, Subchapter B, Chapter 1451, applies 
to a health benefit plan issuer with reference to coverage for the 
diagnosis and treatment of eating disorders.
	(b)  A health benefit plan issuer:                                      
		(1)  may not exclude or limit coverage for diagnosis or 
treatment of an eating disorder based on the type of facility in 
which the diagnosis or treatment occurs; and
		(2)  must allow an insured to receive diagnosis or 
treatment of an eating disorder at an outpatient, inpatient, or 
residential facility.
	SECTION 2.  Chapter 1371, Insurance Code, as added by this 
Act, applies only to a health benefit plan  that is delivered, 
issued for delivery, or renewed on or after January 1, 2006.  A 
health benefit plan that is delivered, issued for delivery, or 
renewed before January 1, 2006, is covered by the law in effect at 
the time the plan was delivered, issued for delivery, or renewed, 
and that law is continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2005.