HB1142 - Relating to coverage for mental health conditions and substance use disorders under certain governmental health benefit plans.

      By: Oliverson, Lambert, Plesa, Lozano, H.B. No. 1142       et al.       A BILL TO BE ENTITLED   AN ACT   relating to coverage for mental health conditions and substance use   disorders under certain governmental health benefit plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1355.002(b), Insurance Code, is amended   to read as follows:          (b)   Except as otherwise provided by this subchapter, but   notwithstanding [ Notwithstanding any provision in Chapter 1575 or   1579 or ] any other law, this subchapter [ Section 1355.015 ] applies   to:                (1)   a basic coverage plan under Chapter 1551;                 (2)   a basic plan under Chapter 1575; [ and ]                 (3)  [ (2) ]  a primary care coverage plan under Chapter   1579 ; and                 (4)     a plan providing basic coverage under Chapter   1601 .          SECTION 2.  Section 1355.003(a), Insurance Code, is amended   to read as follows:          (a)  This subchapter does not apply to coverage under:                (1)  a blanket accident and health insurance policy, as   described by Chapter 1251;                (2)  a short-term travel policy;                (3)  an accident-only policy;                (4)  a limited or specified-disease policy that does   not provide benefits for mental health care or similar services;                (5)  [ except as provided by Subsection (b), a plan   offered under Chapter 1551 or Chapter 1601;                [ (6) ]  a plan offered in accordance with Section   1355.151; or                 (6)  [ (7) ]  a Medicare supplement benefit plan, as   defined by Section 1652.002.          SECTION 3.  Section 1355.015(e), Insurance Code, is amended   to read as follows:          (e)  Notwithstanding any other law, this section does not   apply to :                 (1)   a standard health benefit plan provided under   Chapter 1507 ;                 (2)  a basic coverage plan under Chapter 1551; or                 (3)     a plan providing basic coverage under Chapter   1601 .          SECTION 4.  Section 1355.252, Insurance Code, is amended by   adding Subsection (d) to read as follows:           (d)     Notwithstanding any other law, this subchapter 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;   and                 (4)     a plan providing basic coverage under Chapter   1601.          SECTION 5.  Section 1355.255, Insurance Code, is amended to   read as follows:          Sec. 1355.255.  COMPLIANCE.   (a)   Except as provided by   Subsection (b), the  [ The ] commissioner shall enforce compliance   with Section 1355.254 by evaluating the benefits and coverage   offered by a health benefit plan for quantitative and   nonquantitative treatment limitations in the following categories:                (1)  in-network and out-of-network inpatient care;                (2)  in-network and out-of-network outpatient care;                (3)  emergency care; and                (4)  prescription drugs.           (b)     With respect to a plan described by Section 1355.252(d),   the applicable trustee, board of trustees, or system shall enforce   compliance with Section 1355.254 by evaluating the benefits and   coverage offered by a health benefit plan for quantitative and   nonquantitative treatment limitations in the following categories:                 (1)  in-network and out-of-network inpatient care;                 (2)  in-network and out-of-network outpatient care;                 (3)  emergency care; and                 (4)  prescription drugs.          SECTION 6.  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 7.  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 8.  The heading to Section 1368.006, Insurance Code,   is amended to read as follows:          Sec. 1368.006.   LIFETIME LIMITATION ON COVERAGE PROHIBITED .          SECTION 9.  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 10.  Section 1551.205, Insurance Code, is amended to   read as follows:          Sec. 1551.205.  LIMITATIONS.  The board of trustees may not   contract for or provide a coverage plan that:                (1)  excludes or limits coverage or services for   acquired immune deficiency syndrome, as defined by the Centers for   Disease Control and Prevention of the United States Public Health   Service, or human immunodeficiency virus infection; or             [Text truncated for display. 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