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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 certain mental |
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illnesses and the amount of the franchise tax incentive for certain |
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small employers that provide health care benefits to employees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1355.003, Insurance Code, is amended to |
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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 limited or specified-disease policy that does |
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not provide benefits for mental health care or similar services; |
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(5) [except as provided by Subsection (b), a plan
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offered under Chapter 1551 or Chapter 1601;
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[(6)] a plan offered in accordance with Section |
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1355.151; or |
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(6) [(7)] a Medicare supplement benefit plan, as |
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defined by 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 2. Section 1355.004, Insurance Code, is amended to |
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read as follows: |
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Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL |
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ILLNESS; COVERAGE PARITY. (a) A group health benefit plan: |
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(1) must provide coverage, based on medical necessity, |
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for the diagnosis and treatment of a serious mental illness under |
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terms at least as favorable as those provided for the diagnosis and |
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treatment of medical and surgical conditions, and in no case [not] |
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less than the following treatments [of serious mental illness] in |
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each calendar year: |
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(A) 45 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 serious |
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mental illness as the plan includes for physical illness; and |
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(4) may not impose treatment limitations or financial |
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requirements on the provision of benefits under this subchapter for |
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a serious mental illness if identical limitations or requirements |
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are not imposed on coverage of benefits for other medical |
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conditions. |
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(b) A group health benefit plan issuer: |
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(1) may not count an outpatient visit for medication |
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management against the number of outpatient visits required to be |
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covered under Subsection (a)(1)(B); and |
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(2) must provide coverage for an outpatient visit |
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described by Subsection (a)(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. |
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SECTION 3. Section 171.1013(b-1), Tax Code, is amended to |
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read as follows: |
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(b-1) This subsection applies to a taxable entity that is a |
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small employer, as that term is defined by Section 1501.002, |
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Insurance Code, and that has not provided health care benefits to |
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any of its employees in the calendar year preceding the beginning |
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date of its reporting period. Subject to Section 171.1014, a |
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taxable entity to which this subsection applies that elects to |
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subtract compensation for the purpose of computing its taxable |
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margin under Section 171.101 may subtract health care benefits as |
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provided under Subsection (b) and may also subtract: |
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(1) for the first 12-month period on which margin is |
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based and in which the taxable entity provides health care benefits |
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to all of its employees, an additional amount equal to: |
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(A) 50 percent of the cost of health care |
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benefits that do not meet the requirements of Section 1355.004, |
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Insurance Code, provided to its employees for that period; or |
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(B) 75 percent of the cost of health care |
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benefits that meet the requirements of Section 1355.004, Insurance |
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Code, provided to its employees for that period; [and] |
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(2) for the second 12-month period on which margin is |
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based and in which the taxable entity provides health care benefits |
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to all of its employees, an additional amount equal to: |
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(A) 25 percent of the cost of health care |
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benefits that do not meet the requirements of Section 1355.004, |
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Insurance Code, provided to its employees for that period; or |
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(B) 50 percent of the cost of health care |
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benefits that meet the requirements of Section 1355.004, Insurance |
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Code, provided to its employees for that period; and |
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(3) for the third 12-month period on which margin is |
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based and in which the taxable entity provides health care benefits |
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to all of its employees, an additional amount equal to 25 percent of |
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the cost of health care benefits that meet the requirements of |
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Section 1355.004, Insurance Code, provided to its employees for |
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that period. |
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SECTION 4. The changes in law made by this Act by the |
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amendment of Sections 1355.003 and 1355.004, Insurance Code, apply |
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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, 2010. A group health benefit plan |
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delivered, issued for delivery, or renewed before January 1, 2010, |
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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 5. The change in law made by this Act by the |
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amendment of Section 171.1013(b-1), Tax Code, applies only to a |
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report originally due on or after the effective date of this Act. |
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SECTION 6. This Act takes effect January 1, 2010. |