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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for certain services relating to postpartum |
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depression under certain health benefit plans and the medical |
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assistance and CHIP perinatal programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 62, Health and Safety Code, is amended by |
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adding Subchapter E to read as follows: |
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SUBCHAPTER E. CHIP PERINATAL PROGRAM |
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Sec. 62.201. DEFINITION. In this subchapter, "postpartum |
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depression" means a disorder with postpartum onset that is |
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categorized as a mood disorder by the American Psychiatric |
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Association in the Diagnostic and Statistical Manual of Mental |
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Disorders, 5th Edition (DSM-5), or a subsequent edition adopted by |
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rule by the executive commissioner. |
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Sec. 62.202. COVERAGE FOR CERTAIN SERVICES REQUIRED. (a) |
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The covered services under the CHIP perinatal program must include, |
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for each woman who gives birth to a child who is enrolled in the CHIP |
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perinatal program before birth, screening and treatment for |
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postpartum depression for the 12-month period after the date the |
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woman gives birth to the child. |
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(b) The coverage for postpartum depression provided under |
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Subsection (a): |
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(1) must provide mental health services to a woman |
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regardless of whether the woman has been found to be a danger to |
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herself or others; and |
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(2) may not place an arbitrary or artificial limit on |
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the amount of services that may be provided. |
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(c) The executive commissioner shall adopt rules necessary |
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to implement this section. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.0249 to read as follows: |
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Sec. 32.0249. SERVICES RELATED TO POSTPARTUM DEPRESSION. |
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(a) For purposes of this section, "postpartum depression" means a |
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disorder with postpartum onset that is categorized as a mood |
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disorder by the American Psychiatric Association in the Diagnostic |
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and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), or |
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a subsequent edition adopted by rule by the executive commissioner. |
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(b) The commission shall provide to a woman who receives |
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medical assistance benefits during a pregnancy screening and |
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treatment for postpartum depression for the 12-month period after |
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the date the woman gives birth. |
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(c) The commission shall provide mental health services to a |
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woman under Subsection (b) regardless of whether the woman has been |
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found to be a danger to herself or others. |
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(d) The commission may not place an arbitrary or artificial |
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limit on the amount of services that may be provided under |
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Subsection (b). |
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(e) The executive commissioner shall adopt rules necessary |
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to implement this section. |
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SECTION 3. Chapter 1366, Insurance Code, is amended by |
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adding Subchapter C to read as follows: |
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SUBCHAPTER C. COVERAGE FOR POSTPARTUM DEPRESSION TREATMENT |
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Sec. 1366.101. DEFINITION. In this subchapter, "postpartum |
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depression" means a disorder with postpartum onset that is |
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categorized as a mood disorder by the American Psychiatric |
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Association in the Diagnostic and Statistical Manual of Mental |
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Disorders, 5th Edition (DSM-5), or a subsequent edition adopted by |
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rule by the commissioner. |
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Sec. 1366.102. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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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 insurance company operating |
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under Chapter 884; |
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(5) a health maintenance organization operating under |
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Chapter 843; |
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(6) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(7) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this subchapter 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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(c) This subchapter does not apply to a qualified health |
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plan if a determination is made under 45 C.F.R. Section 155.170 |
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that: |
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(1) this chapter requires the plan to offer benefits |
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in addition to the essential health benefits required under 42 |
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U.S.C. Section 18022(b); and |
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(2) this state is required to defray the cost of the |
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benefits mandated under this chapter. |
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Sec. 1366.103. COVERAGE FOR CERTAIN SERVICES REQUIRED. (a) |
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A health benefit plan that provides maternity benefits must provide |
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to a woman who gives birth to a child coverage for screening and |
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treatment for postpartum depression for the 12-month period after |
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the date the woman gives birth to the child. |
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(b) The coverage for postpartum depression provided under |
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Subsection (a): |
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(1) must provide mental health services to a woman |
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regardless of whether the woman has been found to be a danger to |
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herself or others; and |
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(2) may not place an arbitrary or artificial limit on |
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the amount of services that may be provided. |
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SECTION 4. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
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Services Commission shall develop and seek a waiver or other |
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appropriate authorization from the Centers for Medicare and |
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Medicaid Services to extend the number of postpartum visits a woman |
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may receive under the CHIP perinatal program in order to implement |
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Section 62.202, Health and Safety Code, as added by this Act. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that an additional waiver or additional |
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authorization from a federal agency is necessary for implementation |
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of that provision, the agency affected by the provision shall |
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request the waiver or authorization and may delay implementing that |
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provision until the waiver or authorization is granted. |
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SECTION 6. Subchapter C, Chapter 1366, Insurance Code, as |
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added by this Act, applies only to a health benefit plan that is |
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delivered, issued for delivery, or renewed on or after January 1, |
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2018. A health benefit plan that is delivered, issued for delivery, |
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or renewed before January 1, 2018, is governed by the law as it |
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existed immediately before the effective date of this Act, and that |
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law is continued in effect for that purpose. |
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SECTION 7. This Act takes effect September 1, 2017. |