BILL ANALYSIS

H.B. 3460

By: Price

Insurance

Committee Report (Unamended)

BACKGROUND AND PURPOSE

Significant legislative efforts have been made to increase access to mental health and substance use disorder care by improving insurance coverage. H.B. 10, enacted during the 85th regular legislative session, requires health plans regulated by the Texas Department of Insurance (TDI) to offer benefits in compliance with parity, meaning that the health plan's treatment limitations for mental health and substance use disorders must be comparable to and applied no more stringently than the treatment limitations for medical-surgical conditions. Additionally, since 2003, these same TDI-regulated plans have been required to provide coverage for serious mental illness, including 45 days of inpatient treatment and 60 visits for outpatient treatment. According to TDI, approximately 15 percent of Texans are covered by TDI-regulated plans. Further improvements are needed to ensure that health plans are in compliance with the parity framework and are providing coverage for serious mental illness.

Existing state parity and serious mental illness coverage requirements do not apply to laws that regulate insurance for state employees, retired teachers, public school employees, and University of Texas and Texas A&M University employees. Federal law requires some of these plans to provide general mental health and substance use disorder coverage and prohibit some of these plans from opting out of the federal parity law. However, under state law these plans are not required to comply with state-level parity laws, and they are not required to provide coverage for serious mental illness. These gaps have caused many public servants to receive inadequate, inequitable health insurance coverage. There are calls for public servants to have the same rights and protections as individuals who have TDI-regulated coverage. H.B. 3460 seeks to require health insurance plans for public servants to comply with the parity framework and to provide coverage for serious mental illness.

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

H.B. 3460 amends the Insurance Code to make provisions relating to group health benefit plan coverage for certain serious mental illnesses and other disorders and provisions relating to coverage for mental health conditions and substance use disorders applicable to the following plans:

·         a basic coverage plan under the Texas Employees Group Benefits Act;

·         a basic plan under the Texas Public School Retired Employees Group Benefits Act;

·         a primary care coverage plan under the Texas School Employees Uniform Group Health Coverage Act; and

·         a plan providing basic coverage under the State University Employees Uniform Insurance Benefits Act.

H.B. 3460 requires the applicable trustee, board of trustees, or system, with respect to such coverage plans, to enforce compliance with provisions relating to coverage for mental health conditions and substance use disorders by evaluating the benefits and coverage offered by a health benefit plan for quantitative and nonquantitative treatment limitations in the following categories:

·         in-network and out-of-network inpatient care;

·         in-network and out-of-network outpatient care;

·         emergency care; and

·         prescription drugs.

H.B. 3460 excludes a basic coverage plan under the Texas Employees Group Benefits Act and a plan providing basic coverage under the State University Employees Uniform Insurance Benefits Act from provisions relating to required coverage for screening a child for autism spectrum disorder at the ages of 18 and 24 months.

H.B. 3460 applies only to a plan year that commences on or after January 1, 2024.

H.B. 3460 repeals Section 1355.003(b), Insurance Code.

EFFECTIVE DATE

September 1, 2023.