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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for the diagnosis and |
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treatment of eating disorders. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1375 to read as follows: |
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CHAPTER 1375. DIAGNOSIS AND TREATMENT OF EATING DISORDERS |
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Sec. 1375.001. DEFINITION. In this subchapter, "eating |
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disorder" means anorexia nervosa, bulimia nervosa, or an eating |
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disorder not otherwise specified, as those terms are defined by the |
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Diagnostic and Statistical Manual of Mental Disorders, 4th edition. |
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Sec. 1375.002. APPLICABILITY OF CHAPTER. (a) Except as |
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provided by this section and notwithstanding any other law, this |
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chapter applies only to a health benefit plan, including a small |
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employer health benefit plan written under Chapter 1501 or coverage |
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provided by a health group cooperative under Subchapter B of that |
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chapter, 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 an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage or similar coverage |
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document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) a reciprocal exchange operating under Chapter 942; |
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(6) a Lloyd's plan operating under Chapter 941; |
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(7) a health maintenance organization operating under |
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Chapter 843; |
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(8) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(9) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) Notwithstanding Section 172.014, Local Government Code, |
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or any other law, this chapter applies to health and accident |
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coverage provided by a risk pool created under Chapter 172, Local |
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Government Code. |
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(c) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(d) Notwithstanding any other law, a standard health |
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benefit plan provided under Chapter 1507 must provide the coverage |
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required by this chapter. |
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Sec. 1375.003. REQUIRED COVERAGE FOR EATING DISORDERS. (a) |
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A health benefit plan must provide coverage for the diagnosis of |
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eating disorders. |
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(b) A health benefit plan, based on medical necessity: |
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(1) must provide coverage for not less than the |
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following treatments of eating disorders in each calendar year: |
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(A) 60 days of inpatient treatment; and |
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(B) 60 visits for outpatient treatment, |
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including group and individual outpatient treatment; |
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(2) may not include a lifetime limitation on the |
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number of days of inpatient treatment or the number of visits for |
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outpatient treatment covered under the plan; and |
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(3) must include the same amount limitations, |
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deductibles, copayments, and coinsurance factors for eating |
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disorders as the plan includes for physical illness not related to |
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an eating disorder and, if applicable, for serious mental illness. |
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(c) A health benefit plan issuer: |
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(1) may not treat an outpatient visit for medication |
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or weight management as an outpatient visit required to be covered |
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under Subsection (b)(1)(B); and |
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(2) must provide coverage for an outpatient visit |
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described by Subsection (b)(1)(B) under the same terms as the |
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coverage the issuer provides for an outpatient visit for the |
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treatment of physical illness not related to an eating disorder |
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and, if applicable, for serious mental illness. |
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Sec. 1375.004. ACCESS TO PROVIDERS AND FACILITIES. (a) |
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Notwithstanding any other law, Subchapter B, Chapter 1451, applies |
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to a health benefit plan issuer with reference to coverage for the |
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diagnosis and treatment of eating disorders. |
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(b) A health benefit plan issuer: |
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(1) may not exclude or limit coverage for diagnosis or |
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treatment of an eating disorder based on the type of facility in |
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which the diagnosis or treatment occurs; and |
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(2) must allow an insured to receive diagnosis or |
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treatment of an eating disorder at an outpatient, inpatient, or |
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residential facility. |
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SECTION 2. Chapter 1375, Insurance Code, as added by this |
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Act, applies only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after January 1, 2010. A |
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health benefit plan that is delivered, issued for delivery, or |
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renewed before January 1, 2010, is covered by the law in effect at |
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the time the plan was delivered, issued for delivery, or renewed, |
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and that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2009. |