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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for mental health conditions and substance use |
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disorders under certain governmental health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1355.002(b), Insurance Code, is amended |
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to read as follows: |
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(b) Except as otherwise provided by this subchapter, but |
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notwithstanding [Notwithstanding any provision in Chapter 1575 or |
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1579 or] any other law, this subchapter [Section 1355.015] applies |
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to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; [and] |
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(3) [(2)] a primary care coverage plan under Chapter |
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1579; and |
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(4) a plan providing basic coverage under Chapter |
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1601. |
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SECTION 2. Section 1355.003(a), Insurance Code, is amended |
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to read as follows: |
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(a) This subchapter does not apply to coverage under: |
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(1) a blanket accident and health insurance policy, as |
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described by Chapter 1251; |
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(2) a short-term travel policy; |
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(3) an accident-only policy; |
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(4) a limited or specified-disease policy that does |
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not provide benefits for mental health care or similar services; |
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(5) [except as provided by Subsection (b), a plan |
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offered under Chapter 1551 or Chapter 1601; |
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[(6)] a plan offered in accordance with Section |
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1355.151; or |
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(6) [(7)] a Medicare supplement benefit plan, as |
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defined by Section 1652.002. |
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SECTION 3. Section 1355.015(e), Insurance Code, is amended |
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to read as follows: |
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(e) Notwithstanding any other law, this section does not |
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apply to: |
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(1) a standard health benefit plan provided under |
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Chapter 1507; |
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(2) a basic coverage plan under Chapter 1551; or |
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(3) a plan providing basic coverage under Chapter |
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1601. |
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SECTION 4. Section 1355.252, Insurance Code, is amended by |
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adding Subsection (d) to read as follows: |
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(d) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) a plan providing basic coverage under Chapter |
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1601. |
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SECTION 5. Section 1355.255, Insurance Code, is amended to |
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read as follows: |
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Sec. 1355.255. COMPLIANCE. (a) Except as provided by |
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Subsection (b), the [The] commissioner shall enforce compliance |
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with Section 1355.254 by evaluating the benefits and coverage |
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offered by a health benefit plan for quantitative and |
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nonquantitative treatment limitations in the following categories: |
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(1) in-network and out-of-network inpatient care; |
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(2) in-network and out-of-network outpatient care; |
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(3) emergency care; and |
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(4) prescription drugs. |
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(b) With respect to a plan described by Section 1355.252(d), |
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the applicable trustee, board of trustees, or system shall enforce |
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compliance with Section 1355.254 by evaluating the benefits and |
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coverage offered by a health benefit plan for quantitative and |
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nonquantitative treatment limitations in the following categories: |
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(1) in-network and out-of-network inpatient care; |
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(2) in-network and out-of-network outpatient care; |
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(3) emergency care; and |
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(4) prescription drugs. |
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SECTION 6. Section 1551.205, Insurance Code, is amended to |
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read as follows: |
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Sec. 1551.205. LIMITATIONS. The board of trustees may not |
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contract for or provide a coverage plan that: |
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(1) excludes or limits coverage or services for |
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acquired immune deficiency syndrome, as defined by the Centers for |
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Disease Control and Prevention of the United States Public Health |
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Service, or human immunodeficiency virus infection; or |
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(2) [provides coverage for serious mental illness that |
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is less extensive than the coverage provided for any physical |
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illness; or |
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[(3)] may provide coverage for prescription drugs to |
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assist in stopping smoking at a lower benefit level than is provided |
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for other prescription drugs. |
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SECTION 7. Section 1355.003(b), Insurance Code, is |
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repealed. |
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SECTION 8. The changes in law made by this Act apply only to |
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a plan year that commences on or after January 1, 2026. A plan year |
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that commenced before January 1, 2026, is governed by the law as it |
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existed immediately before the effective date of this Act, and that |
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law is continued in effect for that purpose. |
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SECTION 9. This Act takes effect September 1, 2025. |