BILL ANALYSIS

 

 

 

C.S.H.B. 340

By: Thompson, Senfronia

Insurance

Committee Report (Substituted)

 

 

 

BACKGROUND AND PURPOSE

 

Texas has long recognized that criteria for mental health diagnoses and services differ between children and adults. Currently, the Insurance Code defines "serious mental illness" according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, which is limited to persons 18 years of age and older. Although children's mental health services are widely covered by public and private health insurers, they are not specifically defined in the Insurance Code. The definition of "serious mental illness" in current law only includes one diagnosis relating to children and young adults, which is depression in childhood and adolescence. Children with severe behavioral or emotional issues often do not meet the criteria as defined in current law because of this overly restrictive definition. Federal parity laws mandate equality of coverage between physical and mental health, but they do not include a definition of children's mental health disorders. Accounting for the serious emotional disturbance, specifically with respect to children, in the Insurance Code will ensure Texas is in compliance with federal parity standards. C.S.H.B. 340 seeks to promote access to mental health services for children through health insurance plans by requiring insurance coverage for serious emotional disturbance of a child and providing for a one-time study on the extent to which those benefits are accessed.

 

CRIMINAL JUSTICE IMPACT

 

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

 

RULEMAKING AUTHORITY

 

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

 

ANALYSIS

 

C.S.H.B. 340 amends the Insurance Code to establish certain insurance coverage requirements for serious emotional disturbance of a child and a related study requirement. The bill defines "serious emotional disturbance of a child" as a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders that results in functional impairment that substantially interferes with or limits a child's role or functioning in family, school, or community services and that satisfies the following:

·         the disorder has been diagnosed or identified, as applicable, in a person who is at least three years of age and younger than 18 years of age by an appropriate licensed professional, as specified by the bill; and

·         the disorder meets at least one of the following criteria:

o   it substantially impairs the person's ability in at least two categories of activities or tasks relating to self-care, engaging in family relationships, functioning in school, or functioning in the community;

o   it creates a risk that the person will be removed from the person's home and placed in a more restrictive environment, including in a facility or program operated by the Department of Family and Protective Services or an agency that is part of the juvenile justice system;

o   it causes the person to display psychotic features or violent behavior or causes the person to pose a danger to the person's self or others; or

o   it results in the person meeting state special education eligibility requirements for emotional disturbance.

 

Insurance Coverage

 

C.S.H.B. 340 does the following with respect to insurance coverage for serious emotional disturbance of a child:

·         requires a group health benefit plan to provide coverage for serious emotional disturbance of a child, based on medical necessity, for not less than 45 days of inpatient treatment and 60 visits for outpatient treatment in each calendar year;

·         prohibits a group health benefit plan from including a lifetime limitation on the number of days of inpatient treatment or the number of visits for outpatient treatment covered under the plan;

·         requires a group health benefit plan to include the same amount of limitations, deductibles, copayments, and coinsurance factors for serious emotional disturbance of a child as the plan includes for physical illness;

·         prohibits a group health benefit plan issuer from counting an outpatient visit for medication management against the number of outpatient visits required to be covered for serious emotional disturbance of a child; and

·         requires a group health benefit plan issuer to provide coverage for an outpatient visit for serious emotional disturbance of a child under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.

 

C.S.H.B. 340 includes coverage of serious emotional disturbance of a child among the coverage a group health benefit plan issuer may provide or offer through a managed care plan and among the coverage a plan issuer must offer a small employer but is not required to provide the coverage if the employer rejects the coverage. The bill includes serious emotional disturbance of a child among the conditions that may qualify a covered individual to receive alternative mental health treatment benefits under the following circumstances:

·         the condition requires confinement of the individual in a hospital unless treatment is available through a residential treatment center for children and adolescents or a crisis stabilization unit; and

·         the condition either substantially impairs the individual's thought, perception of reality, emotional process, or judgment or, as manifested by the individual's recent disturbed behavior, grossly impairs the individual's behavior.

 

C.S.H.B. 340 applies only to a group health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2024.      

 

Study

 

C.S.H.B. 340 requires the Texas Department of Insurance (TDI) to conduct a study to determine and evaluate the extent to which enrollees are making claims under coverage for serious emotional disturbance of a child and the impact, if any, the coverage and the claims have on the cost of the coverage for group health benefit plans. The bill requires TDI, not later than December 1, 2024, to submit to the governor, the lieutenant governor, the speaker of the house of representatives, and the appropriate standing committees of the legislature a report regarding the results of the study, together with any recommendations for legislation. These provisions expire September 1, 2025.

 

EFFECTIVE DATE

 

September 1, 2023.

 

COMPARISON OF INTRODUCED AND SUBSTITUTE

 

While C.S.H.B. 340 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

 

Whereas the introduced defined "serious emotional disturbance of a child" in part as an emotional or behavioral disorder or a neuropsychiatric condition that causes a person's functioning to be impaired in thought, perception, affect, or behavior, the substitute defines "serious emotional disturbance of a child" in part as a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders that results in functional impairment that substantially interferes with or limits a child's role or functioning in family, school, or community services.

 

The substitute does not include a provision exempting TRS-Care and TRS‑ActiveCare from the bill's coverage provisions, which was present in the introduced.

 

The substitute changes the deadline for submission of TDI's study from August 1, 2024, as in the introduced, to December 1, 2024.