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A BILL TO BE ENTITLED
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AN ACT
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relating to required coverage for obesity under group health |
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benefit plans. |
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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 1372 to read as follows: |
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CHAPTER 1372. OBESITY |
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Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a group health benefit plan that provides benefits |
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for medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including a group insurance |
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policy, group insurance agreement, group hospital service |
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contract, 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 health maintenance organization operating under |
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Chapter 843; |
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(4) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(5) a stipulated premium company operating under |
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Chapter 884; or |
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(6) a fraternal benefit society operating under |
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Chapter 885. |
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(b) Notwithstanding any other law, this chapter applies to |
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group coverage provided through a small employer health benefit |
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plan subject to Chapter 1501, including group coverage provided |
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through a health group cooperative under Subchapter B of that |
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chapter. |
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Sec. 1372.002. CONDITIONAL EXCEPTION. This chapter does |
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not apply to a qualified health plan if a determination is made |
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under 45 C.F.R. Section 155.170 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. 1372.003. REQUIRED COVERAGE FOR OBESITY. (a) A group |
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health benefit plan must provide coverage, based on medical |
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necessity, for the diagnosis and treatment of obesity. |
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(b) Coverage required under Subsection (a) is limited to a |
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service, including bariatric surgery and nutritional counseling |
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and therapy, or a medication, to the extent the group health benefit |
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plan provides pharmacy benefits, ordered by a licensed physician, |
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psychiatrist, psychologist, or therapist within the scope of the |
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practitioner's license and in accordance with a treatment plan. |
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(c) On request from the group health benefit plan issuer, an |
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obesity treatment plan must include all elements necessary for the |
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issuer to pay a claim under the group health benefit plan, which may |
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include a diagnosis, goals, and proposed treatment by type, |
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frequency, and duration. |
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SECTION 2. Not later than November 1 of each even-numbered |
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year, the comptroller of public accounts shall prepare and submit |
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to the legislature a biennial report on the human and financial cost |
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of obesity in this state. This section expires December 1, 2020. |
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SECTION 3. The changes in law made by this Act apply only to |
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a group health benefit plan delivered, issued for delivery, or |
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renewed on or after January 1, 2018. |
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SECTION 4. This Act takes effect September 1, 2017. |