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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for eating disorders under certain 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. Section 1355.001, Insurance Code, is amended by |
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adding Subdivisions (5) to read as follows: |
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(5) "Eating disorder" means: |
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(A) any eating disorder described by the |
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Diagnostic and Statistical Manual of Mental Disorders, fifth |
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edition, or a later edition adopted by the commissioner by rule, |
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including: |
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(i) anorexia nervosa; |
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(ii) bulimia nervosa; |
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(iii) binge eating disorder; |
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(iv) rumination disorder; |
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(v) avoidant/restrictive food intake |
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disorder; or |
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(vi) any eating disorder not otherwise |
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specified; or |
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(B) any eating disorder contained in a subsequent |
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edition of the Diagnostic and Statistical Manual of Mental |
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Disorders published by the American Psychiatric Association and |
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adopted by the commissioner by rule. |
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SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is |
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amended by adding Section 1355.008 to read as follows: |
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Sec. 1355.008. REQUIRED COVERAGE FOR EATING DISORDERS. (a) |
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A health benefit plan must provide coverage, based on medical |
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necessity, for the diagnosis and treatment of an eating disorder. |
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(b) Coverage required under Subsection (a) is limited to a |
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service or medication, to the extent the service or medication is |
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covered by the health benefit plan, ordered by a licensed |
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physician, psychiatrist, psychologist, or therapist within the |
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scope of the practitioner's license and in accordance with a |
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treatment plan. |
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(c) On request from the health benefit plan issuer, an |
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eating disorder treatment plan must include all elements necessary |
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for the issuer to pay a claim under the health benefit plan, which |
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may include a diagnosis, goals, and proposed treatment by type, |
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frequency, and duration. |
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(d) Coverage required under Subsection (a) is not subject to |
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a limit on the number of days of medically necessary treatment |
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except as provided by the treatment plan. |
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(e) A health benefit plan issuer may conduct a utilization |
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review of an eating disorder treatment plan not more than once each |
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six months unless the physician, psychiatrist, psychologist, or |
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therapist treating the enrollee under the treatment plan agrees |
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that a more frequent review is necessary. An agreement to conduct |
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more frequent review under this subsection applies only to the |
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enrollee who is the subject of the agreement. |
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(f) A health benefit plan issuer shall pay any costs of |
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conducting a utilization review of coverage required under |
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Subsection (a) or obtaining a treatment plan. |
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(g) In conducting a utilization review of treatment for an |
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eating disorder, including review of medical necessity or the |
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treatment plan, a utilization review agent shall consider: |
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(1) the overall medical and mental health needs of the |
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individual with the eating disorder; |
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(2) factors in addition to weight; and |
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(3) the most recent Practice Guideline for the |
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Treatment of Patients with Eating Disorders adopted by the American |
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Psychiatric Association. |
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SECTION 3. The changes in law made by this Act apply only to |
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a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2018. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2018, |
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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 4. This Act takes effect September 1, 2017. |