HB1045 - Relating to health benefit plan coverage of treatment for chemical dependency.

  89R3557 RDR-D     By: Turner H.B. No. 1045       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage of treatment for chemical   dependency.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1368.001(2), Insurance Code, is amended   to read as follows:                (2)  "Chemical dependency treatment center" means a   facility that provides a program for the treatment of chemical   dependency under a written treatment plan approved and monitored by   a physician and that is:                      (A)  affiliated with a hospital under a   contractual agreement with an established system for patient   referral;                      (B)  accredited as a chemical dependency   treatment center by the Joint Commission on Accreditation of   Healthcare Organizations;                      (C)  licensed as a chemical dependency treatment   program by the Health and Human Services [ Texas ] Commission [ on   Alcohol and Drug Abuse ]; or                      (D)  licensed, certified, or approved as a   chemical dependency treatment program or center by another state   agency.          SECTION 2.  Sections 1368.002, 1368.003, and 1368.004,   Insurance Code, are amended to read as follows:          Sec. 1368.002.  APPLICABILITY OF CHAPTER. (a) This chapter   applies only to a [ group ] health benefit plan that provides   hospital and medical coverage or services on an expense incurred,   service, or prepaid basis, including an individual or a group   insurance policy or contract or self-funded or self-insured plan or   arrangement that is offered in this state by:                (1)  an insurer;                (2)  a group hospital service corporation operating   under Chapter 842;                (3)  a health maintenance organization operating under   Chapter 843; or                (4)  an employer, trustee, or other self-funded or   self-insured plan or arrangement.           (b)  Notwithstanding any other law, this chapter applies to:                 (1)  a basic coverage plan under Chapter 1551;                 (2)  a basic plan under Chapter 1575;                   (3)     a primary care coverage plan under Chapter 1579;   or                 (4)     a plan providing basic coverage under Chapter   1601.          Sec. 1368.003.  EXCEPTION.  This chapter does not apply to:                (1)  [ an employer, trustee, or other self-funded or   self-insured plan or arrangement with 250 or fewer employees or   members;                [ (2)  an individual insurance policy;                [ (3)     an individual evidence of coverage issued by a   health maintenance organization;                [ (4) ]  a health insurance policy that provides only:                      (A)  cash indemnity for hospital or other   confinement benefits;                      (B)  supplemental or limited benefit coverage;                      (C)  coverage for specified diseases or   accidents;                      (D)  disability income coverage; or                      (E)  any combination of those benefits or   coverages;                 (2)  [ (5) ]  a blanket insurance policy;                 (3)  [ (6) ]  a short-term travel insurance policy;                 (4)  [ (7) ]  an accident-only insurance policy;                 (5)  [ (8) ]  a limited or specified disease insurance   policy;                 (6)  [ (9) ]  an individual conversion insurance policy   or contract;                 (7)  [ (10) ]  a policy or contract designed for issuance   to a person eligible for Medicare coverage or other similar   coverage under a state or federal government plan; or                 (8)  [ (11) ]  an evidence of coverage provided by a   health maintenance organization if the plan holder is the subject   of a collective bargaining agreement that was in effect on January   1, 1982, and that has not expired since that date.          Sec. 1368.004.  COVERAGE REQUIRED.  (a)  A [ group ] health   benefit plan shall provide coverage for the necessary care and   treatment of chemical dependency.          (b)  Coverage required under this section may be provided:                (1)  directly by the [ group ] health benefit plan   issuer; or                (2)  by another entity, including a single service   health maintenance organization, under contract with the [ group ]   health benefit plan issuer.          SECTION 3.  Section 1368.005(a), Insurance Code, is amended   to read as follows:          (a)   Coverage [ Except as provided by Subsection (b),   coverage ] required under this chapter[ :                [ (1) ]  may not be less favorable than coverage provided   for physical illness generally under the plan[ ; and                [ (2)     shall 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 ].          SECTION 4.  The heading to Section 1368.006, Insurance Code,   is amended to read as follows:          Sec. 1368.006.   LIFETIME LIMITATION ON COVERAGE PROHIBITED .          SECTION 5.  Section 1368.006(b), Insurance Code, is amended   to read as follows:          (b)   Coverage [ Notwithstanding Section 1368.005, coverage ]   required under this chapter may not be subject [ is limited ] to a   lifetime maximum [ of three separate treatment series for each   covered individual ].          SECTION 6.  Sections 1368.007(a) and (b), Insurance Code,   are amended to read as follows:          (a)  Coverage provided under this chapter for necessary care   and treatment in a chemical dependency treatment center must be   provided at an appropriate level of [ as if the ] care [ and treatment   were provided in a hospital ].          (b)  The commissioner [ department ] by rule shall adopt   standards formulated and approved by the commissioner [ department ]   and the executive commissioner of the Health and Human Services   Commission [ Texas Commission on Alcohol and Drug Abuse ] for use by   insurers, other third-party reimbursement sources, and chemical   dependency treatment centers.          SECTION 7.  Sections 1368.005(b) and 1368.006(a), Insurance   Code, are repealed.          SECTION 8.  The changes in law made by this Act apply only to   a health benefit plan that is delivered, issued for delivery, or   renewed on or after January 1, 2026. A health benefit plan   delivered, issued for delivery, or renewed before January 1, 2026,   is governed by the law as it existed immediately before the   effective date of this Act, and that law is continued in effect for   that purpose.          SECTION 9.  This Act takes effect September 1, 2025.