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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 certain serious mental |
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illnesses and mental disorders. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1355.001, Insurance Code, is amended by |
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amending Subdivision (1) and adding Subdivision (5) to read as |
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follows: |
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(1) "Serious mental illness" means [the following] |
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psychiatric illnesses as defined by the American Psychiatric |
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Association in the Diagnostic and Statistical Manual (DSM), fourth |
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edition, or a later edition of that manual that the commissioner |
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adopts by rule. The term includes: |
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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) schizo-affective disorders (bipolar or |
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depressive); and |
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(G) schizophrenia. |
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(5) "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 (DSM), fourth edition, or a later edition of that manual that |
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the commissioner adopts by rule. The term does not include: |
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(A) a condition classified by the manual as a |
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"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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SECTION 2. Subchapter F, Chapter 1501, Insurance Code, is |
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amended by adding Section 1501.253 to read as follows: |
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Sec. 1501.253. MENTAL HEALTH BENEFITS. (a) In this |
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section: |
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(1) "Mental disorder" has the meaning assigned by |
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Section 1355.001. |
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(2) "Serious mental illness" has the meaning assigned |
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by Section 1355.001. |
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(b) Notwithstanding Chapter 1507, a small employer health |
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benefit plan issuer shall offer coverage under the standard health |
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benefit plan offered under Section 1501.252, based on medical |
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necessity, for treatment of a serious mental illness or a mental |
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disorder that is not classified as a serious mental illness that is |
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equal to the coverage the plan includes for physical illness. The |
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issuer is not required to provide the coverage required under this |
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subsection if the employer rejects the coverage. |
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SECTION 3. Subchapter M, Chapter 1501, Insurance Code, is |
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amended by adding Section 1501.6025 to read as follows: |
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Sec. 1501.6025. MENTAL HEALTH BENEFITS. (a) In this |
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section: |
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(1) "Mental disorder" has the meaning assigned by |
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Section 1355.001. |
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(2) "Serious mental illness" has the meaning assigned |
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by Section 1355.001. |
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(b) A large employer health benefit plan issuer shall offer |
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coverage, based on medical necessity, for treatment of a mental |
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disorder that is not classified as a serious mental illness that is |
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equal to the coverage the plan includes for physical illness. The |
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issuer is not required to provide the coverage required under this |
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subsection if the employer rejects the coverage. |
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SECTION 4. The change in law made by this Act applies only |
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to a small employer health benefit plan or large employer health |
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benefit plan that is delivered, issued for delivery, or renewed on |
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or after January 1, 2010. A health benefit plan that is delivered, |
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issued for delivery, or renewed before January 1, 2010, is covered |
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by the law in effect at the time the plan was delivered, issued for |
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delivery, or renewed, and that law is continued in effect for that |
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purpose. |
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SECTION 5. This Act takes effect September 1, 2009. |