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A BILL TO BE ENTITLED
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AN ACT
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relating to statewide standards for the provision of and health |
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benefit plan coverage of substance use and addiction treatment. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle I, Title 4, Government Code, is amended |
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by adding Chapter 542 to read as follows: |
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CHAPTER 542. SUBSTANCE USE AND ADDICTION TREATMENT |
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Sec. 542.001. STANDARDS FOR SUBSTANCE USE AND ADDICTION |
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TREATMENT. In carrying out the commission's duties under law in |
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relation to the provision of substance use and addiction treatment, |
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including the designation of appropriate levels of care, the |
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transfer or discharge of a patient, and the utilization management |
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review of care and treatment provided to individuals suffering from |
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a substance use, mental health, or co-occurring disorder, the |
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commission shall endeavor to use and encourage the use of the most |
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recently published standards on substance use and addiction |
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treatment by the American Society of Addiction Medicine, including |
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the use of those standards for determining the level of care and |
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authorizing payment commensurate with the level of care indicated |
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by a health benefit plan. |
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Sec. 542.002. MEMORANDUM OF UNDERSTANDING. To encourage |
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the use of standards described by Section 542.001 by other state |
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agencies and local governmental entities, the commission may adopt |
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a memorandum of understanding with those agencies and entities to |
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coordinate the use of and authorize the payment for services |
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delivered in accordance with those standards. |
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SECTION 2. Chapter 1355, Insurance Code, is amended by |
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adding Subchapter G to read as follows: |
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SUBCHAPTER G. CLASSIFICATION AND DETERMINATION OF COVERAGE FOR |
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MENTAL ILLNESS |
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Sec. 1355.301. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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issued by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) nonprofit agricultural organization health |
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benefits offered by a nonprofit agricultural organization under |
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Chapter 1682; |
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(8) alternative health benefit coverage offered by a |
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subsidiary of the Texas Mutual Insurance Company under Subchapter |
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M, Chapter 2054; |
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(9) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(10) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(11) the state Medicaid program, including the |
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Medicaid managed care program operated under Chapter 533, |
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Government Code; |
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(12) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(13) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(14) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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(15) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(16) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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Sec. 1355.302. REQUIRED USE OF MANUAL. A health benefit |
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plan that provides coverage for mental health or substance use |
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disorders must use the Diagnostic and Statistical Manual of Mental |
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Disorders, 5th edition, for purposes of classifying and determining |
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coverage for mental illness. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. Section 1355.302, Insurance Code, as added by |
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this Act, applies only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after January 1, 2024. |
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SECTION 5. This Act takes effect September 1, 2023. |