81R4451 TJS-D

By: Bolton H.B. No. 1121

A BILL TO BE ENTITLED

AN ACT

relating to group health benefit plan coverage for certain mental illnesses.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1355.003, Insurance Code, is amended to read as follows:

Sec. 1355.003. EXCEPTION. [(a)] This subchapter does not apply to coverage under:

(1) a blanket accident and health insurance policy, as described by Chapter 1251;

(2) a short-term travel policy;

(3) an accident-only policy;

(4) a limited or specified-disease policy that does not provide benefits for mental health care or similar services;

(5) [except as provided by Subsection (b), a plan offered under Chapter 1551 or Chapter 1601;

[(6)] a plan offered in accordance with Section 1355.151; or

(6) [(7)] a Medicare supplement benefit plan, as defined by Section 1652.002.

[(b) For the purposes of a plan described by Subsection (a)(5), "serious mental illness" has the meaning assigned by Section 1355.001.]

SECTION 2. Section 1355.004, Insurance Code, is amended to read as follows:

Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS; COVERAGE PARITY. (a) A group health benefit plan:

(1) must provide coverage, based on medical necessity, for the diagnosis and treatment of a serious mental illness under terms at least as favorable as those provided for the diagnosis and treatment of medical and surgical conditions, and in no case [not] less than the following treatments [of serious mental illness] in each calendar year:

(A) 45 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 serious mental illness as the plan includes for physical illness; and

(4) may not impose treatment limitations or financial requirements on the provision of benefits under this subchapter for a serious mental illness if identical limitations or requirements are not imposed on coverage of benefits for other medical conditions.

(b) A group health benefit plan issuer:

(1) may not count an outpatient visit for medication management against the number of outpatient visits required to be covered under Subsection (a)(1)(B); and

(2) must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.

SECTION 3. The change in law made by this Act applies only to a group health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2010. A group health benefit plan delivered, issued for delivery, or renewed before January 1, 2010, is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose.

SECTION 4. This Act takes effect September 1, 2009.