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  By: Coleman H.B. No. 3891
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
 
  relating to coverage for eating disorders under certain health
  benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1355.001, Insurance Code, is amended by
  adding Subdivisions (5) to read as follows:
               (5)  "Eating disorder" means:
                     (A)  any eating disorder described by the
  Diagnostic and Statistical Manual of Mental Disorders, fifth
  edition, or a later edition adopted by the commissioner by rule,
  including:
                           (i)  anorexia nervosa;
                           (ii)  bulimia nervosa;
                           (iii)  binge eating disorder;
                           (iv)  rumination disorder;
                           (v)  avoidant/restrictive food intake
  disorder; or
                           (vi)  any eating disorder not otherwise
  specified; or
                     (B)  any eating disorder contained in a subsequent
  edition of the Diagnostic and Statistical Manual of Mental
  Disorders published by the American Psychiatric Association and
  adopted by the commissioner by rule.
         SECTION 2.  Subchapter A, Chapter 1355, Insurance Code, is
  amended by adding Section 1355.008 to read as follows:
         Sec. 1355.008.  REQUIRED COVERAGE FOR EATING DISORDERS. (a)
  A health benefit plan must provide coverage, based on medical
  necessity, for the diagnosis and treatment of an eating disorder.
         (b)  Coverage required under Subsection (a) is limited to a
  service or medication, to the extent the service or medication is
  covered by the health benefit plan, ordered by a licensed
  physician, psychiatrist, psychologist, or therapist within the
  scope of the practitioner's license and in accordance with a
  treatment plan.
         (c)  On request from the health benefit plan issuer, an
  eating disorder treatment plan must include all elements necessary
  for the issuer to pay a claim under the health benefit plan, which
  may include a diagnosis, goals, and proposed treatment by type,
  frequency, and duration.
         (d)  Coverage required under Subsection (a) is not subject to
  a limit on the number of days of medically necessary treatment
  except as provided by the treatment plan.
         (e)  A health benefit plan issuer may conduct a utilization
  review of an eating disorder treatment plan not more than once each
  six months unless the physician, psychiatrist, psychologist, or
  therapist treating the enrollee under the treatment plan agrees
  that a more frequent review is necessary. An agreement to conduct
  more frequent review under this subsection applies only to the
  enrollee who is the subject of the agreement.
         (f)  A health benefit plan issuer shall pay any costs of
  conducting a utilization review of coverage required under
  Subsection (a) or obtaining a treatment plan.
         (g)  In conducting a utilization review of treatment for an
  eating disorder, including review of medical necessity or the
  treatment plan, a utilization review agent shall consider:
               (1)  the overall medical and mental health needs of the
  individual with the eating disorder;
               (2)  factors in addition to weight; and
               (3)  the most recent Practice Guideline for the
  Treatment of Patients with Eating Disorders adopted by the American
  Psychiatric Association.
         SECTION 3.  The changes in law made by this Act apply only to
  a health benefit plan that is delivered, issued for delivery, or
  renewed on or after January 1, 2018. A health benefit plan that is
  delivered, issued for delivery, or renewed before January 1, 2018,
  is governed by the law as it existed immediately before the
  effective date of this Act, and that law is continued in effect for
  that purpose.
         SECTION 4.  This Act takes effect September 1, 2017.