BILL ANALYSIS

H.B. 5121

By: Turner

Insurance

Committee Report (Unamended)

BACKGROUND AND PURPOSE

The Texas Mental Health Condition and Substance Use Disorder Parity Strategic Plan states that the Texas Legislature should enact legislation to modernize the mental health and chemical dependency statutes. H.B. 5121 seeks to clarify and simplify coverage language to be consistent with existing parity language, removes treatment limitations that are inconsistent with existing parity laws, and ensures that all state-regulated health benefit plans are subject to consistent coverage standards for serious mental illness and chemical dependency treatment. The bill additionally updates outdated agency references and directs the Health and Human Services Commission to adopt standards to be used by insurers, third-party reimbursement services, and chemical dependency treatment centers.

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. 5121 amends the Insurance Code to extend the applicability of provisions relating to coverage for the necessary care and treatment of chemical dependency to include the following health benefit 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.

The bill additionally removes as exceptions to that applicability an employer, trustee, or other self-funded or self-insured plan or arrangement with 250 or fewer employees or members, an individual insurance policy, and an individual evidence of coverage issued by a health maintenance organization.

H.B. 5121 removes the requirement that chemical dependency coverage provided under a plan be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors that apply to coverage provided for physical illness generally under the plan. The bill repeals a provision that does the following:

· authorizes a plan to set dollar or durational limits that are less favorable than the coverage provided for physical illness generally under the plan if those limits are sufficient to provide appropriate care and treatment under the guidelines and standards adopted by the Texas Department of Insurance (TDI) for use by insurers, other third-party reimbursement sources, and chemical dependency treatment centers; and

· prohibits the dollar and durational limits from being less favorable than for physical illness generally if the guidelines and standards are not in effect.

The bill clarifies that the agency charged with formulating and approving the standards in conjunction with TDI and charged with licensing chemical dependency treatment programs is the Health and Human Services Commission. The bill replaces the treatment standard that chemical dependency coverage for necessary care and treatment in a chemical dependency treatment center be provided as if the care and treatment were provided in a hospital with the standard that such coverage for necessary care and treatment in a chemical dependency treatment center be provided at an appropriate level of care.

H.B. 5121 removes the lifetime chemical dependency coverage limit of three separate treatment series for each covered individual and instead prohibits the coverage from being subject to a lifetime maximum. The bill repeals the definition of "treatment series."

H.B. 5121 applies only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2024.

H.B. 5121 repeals Sections 1368.005(b) and 1368.006(a), Insurance Code.

EFFECTIVE DATE

September 1, 2023.