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A BILL TO BE ENTITLED
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AN ACT
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relating to group health benefit plan coverage for an enrollee with |
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certain mental disorders. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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ARTICLE 1. AMENDMENTS TO CHAPTER 1355, INSURANCE CODE |
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SECTION 1.01. The heading to Subchapter A, Chapter 1355, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER A. [GROUP] HEALTH BENEFIT PLAN COVERAGE FOR |
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CERTAIN MENTAL DISORDERS AND SERIOUS MENTAL ILLNESSES |
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SECTION 1.02. Section 1355.001, Insurance Code, is amended |
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to read as follows: |
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Sec. 1355.001. DEFINITIONS. In this subchapter: |
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(1) "Enrollee" means an individual who is enrolled in |
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a group health benefit plan, including a covered dependent. |
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(2) "Mental disorder" means a disorder defined by the |
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American Psychiatric Association in the Diagnostic and Statistical |
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Manual of Mental Disorders (DSM), fourth edition, or a subsequent |
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edition of that manual that the commissioner by rule adopts to take |
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the place of the fourth edition, except that the term does not |
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include: |
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(A) a mental disorder classified under that |
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manual as a "V-code" disorder; |
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(B) mental retardation; |
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(C) a learning disorder; |
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(D) a motor skill disorder; or |
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(E) a communication disorder. |
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(3) "Serious mental illness" means a mental disorder |
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that is one of the following psychiatric illnesses as defined by the |
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American Psychiatric Association in the Diagnostic and Statistical |
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Manual of Mental Disorders (DSM), fourth edition, or a subsequent |
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edition of that manual that the commissioner by rule adopts to take |
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the place of the fourth edition: |
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(A) bipolar disorders (hypomanic, manic, |
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depressive, and mixed); |
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(B) depression in childhood and adolescence; |
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(C) major depressive disorders (single episode |
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or recurrent); |
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(D) obsessive-compulsive disorders; |
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(E) paranoid and other psychotic disorders; |
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(F) pervasive developmental disorders; |
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(G) schizo-affective disorders (bipolar or |
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depressive); and |
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(H) schizophrenia. |
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(4) [(2)] "Small employer" has the meaning assigned by |
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Section 1501.002. |
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SECTION 1.03. Section 1355.002, Insurance Code, is amended |
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to read as follows: |
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Sec. 1355.002. CONSTRUCTION AND APPLICABILITY OF |
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SUBCHAPTER. (a) This subchapter may not be construed to limit any |
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medical treatment described in a billing code listed in the |
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International Classification of Diseases, ninth edition, of the |
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World Health Organization, or a subsequent edition of that |
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publication that the commissioner by rule adopts to take the place |
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of the ninth edition. |
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(b) This subchapter applies only to a group health benefit |
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plan that provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including: |
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(1) a group insurance policy, group insurance |
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agreement, group hospital service contract, or group evidence of |
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coverage that is offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; [or] |
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(E) a health maintenance organization operating |
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under Chapter 843; |
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(F) a reciprocal exchange operating under |
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Chapter 942; |
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(G) a Lloyd's plan operating under Chapter 941; |
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or |
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(H) an approved nonprofit health corporation |
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that holds a certificate of authority under Chapter 844; and |
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(2) [to the extent permitted by the Employee
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
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seq.), a plan offered under:
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[(A)] a multiple employer welfare arrangement |
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that holds a certificate of authority under Chapter 846 [as defined
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by Section 3 of that Act; or
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[(B)another analogous benefit arrangement]. |
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SECTION 1.04. Section 1355.003, Insurance Code, is amended |
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to read as follows: |
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Sec. 1355.003. EXCEPTION. [(a)] This subchapter does not |
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apply to coverage under: |
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(1) a blanket accident and health insurance policy, as |
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described by Chapter 1251; |
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(2) a short-term travel policy; |
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(3) an accident-only policy; |
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(4) a plan that provides coverage: |
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(A) only for benefits for a specified disease or |
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for another limited benefit, other than a plan that provides |
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benefits for mental health or similar services; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; |
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(E) only for dental or vision care; or |
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(F) only for indemnity for hospital confinement; |
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(5) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(6) a workers' compensation insurance policy; |
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(7) medical payment insurance coverage provided under |
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an automobile insurance policy; |
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(8) a credit insurance policy; |
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(9) a long-term care insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefit coverage so |
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comprehensive that the policy is a group health benefit plan as |
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described by Section 1355.002 [limited or specified-disease policy
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that does not provide benefits for mental health care or similar
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services]; |
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(10) [(5)] except as provided by Section 1355.0035(b) |
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[Subsection (b)], a plan offered under Chapter 1551 or Chapter |
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1601; or |
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(11) [(6)] a plan offered in accordance with Section |
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1355.151[; or
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[(7) a Medicare supplement benefit plan, as defined by
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Section 1652.002]. |
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[(b) For the purposes of a plan described by Subsection
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(a)(5), "serious mental illness" has the meaning assigned by
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Section 1355.001.] |
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SECTION 1.05. Subchapter A, Chapter 1355, Insurance Code, |
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is amended by adding Section 1355.0035 to read as follows: |
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Sec. 1355.0035. REQUIRED COVERAGE FOR MENTAL DISORDERS. |
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(a) Except as provided by Subsections (b) and (c), a group health |
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benefit plan must provide coverage for the diagnosis and medically |
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necessary treatment of an enrollee's mental disorder under terms at |
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least as favorable as coverage provided to the enrollee for the |
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diagnosis and treatment of medical and surgical conditions. |
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(b) The group benefits program under Chapter 1551 must |
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provide coverage for mental disorders as required by Section |
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1551.205. The uniform program offered under Chapter 1601 may limit |
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coverage under this chapter to the coverage required under Section |
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1355.004. |
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(c) This section does not apply to a consumer choice of |
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benefits health insurance plan under Chapter 1507. |
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SECTION 1.06. Section 1355.004, Insurance Code, is amended |
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by adding Subsection (c) to read as follows: |
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(c) This section does not apply to a group health benefit |
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plan required to provide coverage under Section 1355.0035(a). |
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SECTION 1.07. Section 1355.005, Insurance Code, is amended |
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to read as follows: |
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Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A group |
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health benefit plan issuer may provide or offer coverage required |
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by Section 1355.0035 or 1355.004 through a managed care plan. |
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SECTION 1.08. Subchapter A, Chapter 1355, Insurance Code, |
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is amended by adding Section 1355.0055 to read as follows: |
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Sec. 1355.0055. COVERAGE EQUITY. (a) A group health |
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benefit plan subject to Section 1355.0035 may not impose treatment |
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limitations or financial requirements on the provision of benefits |
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under this subchapter for a mental disorder if identical |
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limitations or requirements are not imposed on coverage of benefits |
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for other medical conditions. |
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(b) A deductible or out-of-pocket limit required under a |
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health benefit plan that is subject to Section 1355.0035 must be |
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comprehensive for coverage of both mental health and physical |
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health conditions. |
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SECTION 1.09. Subchapter A, Chapter 1355, Insurance Code, |
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is amended by adding Section 1355.008 to read as follows: |
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Sec. 1355.008. RULES. The commissioner shall adopt rules |
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as necessary to administer this subchapter. |
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SECTION 1.10. Section 1355.151, Insurance Code, is amended |
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to read as follows: |
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Sec. 1355.151. PROHIBITION ON EXCLUSION OR LIMITATION OF |
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CERTAIN COVERAGES. (a) In this section, "mental disorder" |
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["serious mental illness"] has the meaning assigned by Section |
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1355.001. |
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(b) A political subdivision that provides group health |
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insurance coverage, health maintenance organization coverage, or |
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self-insured health care coverage to the political subdivision's |
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officers or employees may not contract for or provide coverage that |
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is less extensive for a mental disorder [serious mental illness] |
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than the coverage provided for any [other] physical illness. |
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ARTICLE 2. CONFORMING AMENDMENTS |
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SECTION 2.01. Section 1551.003, Insurance Code, is amended |
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by adding Subdivision (10-a) to read as follows: |
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(10-a) "Mental disorder" has the meaning assigned by |
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Section 1355.001(2). |
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SECTION 2.02. Section 1551.205, Insurance Code, is amended |
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to read as follows: |
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Sec. 1551.205. LIMITATIONS. The board of trustees may not |
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contract for or provide a coverage plan that: |
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(1) excludes or limits coverage or services for |
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acquired immune deficiency syndrome, as defined by the Centers for |
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Disease Control and Prevention of the United States Public Health |
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Service, or human immunodeficiency virus infection; |
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(2) provides coverage for a mental disorder [serious
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mental illness] that is less extensive than the coverage provided |
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for any physical illness; or |
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(3) may provide coverage for prescription drugs to |
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assist in stopping smoking at a lower benefit level than is provided |
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for other prescription drugs. |
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SECTION 2.03. Section 1601.109, Insurance Code, is amended |
|
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to read as follows: |
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Sec. 1601.109. COVERAGE FOR AIDS, HIV, OR [SERIOUS] MENTAL |
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DISORDER [ILLNESS]. (a) In this section, "mental disorder" |
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["serious mental illness"] has the meaning assigned by Section |
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1355.001 [1, Article 3.51-14]. |
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(b) A system may not contract for or provide for group |
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insurance or HMO coverage or provide self-insured coverage, that: |
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(1) excludes or limits coverage or services for |
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acquired immune deficiency syndrome, as defined by the Centers for |
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Disease Control and Prevention of the United States Public Health |
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Service, or human immunodeficiency virus infection; or |
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(2) provides coverage for a mental disorder [serious
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mental illness] that is less extensive than the coverage provided |
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for any [other] physical illness. |
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ARTICLE 3. TRANSITION; EFFECTIVE DATE |
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SECTION 3.01. The change in law made by this Act applies |
|
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only to a group health benefit plan delivered, issued for delivery, |
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or renewed on or after January 1, 2008. A group health benefit plan |
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delivered, issued for delivery, or renewed before January 1, 2008, |
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is governed by the law as it existed immediately before the |
|
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 3.02. This Act takes effect September 1, 2007. |