HB1396 - Relating to coverage for mental health conditions and substance use disorders under certain governmental health benefit plans.

      By: Talarico H.B. No. 1396       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.  Section 1355.003(b), Insurance Code, is   repealed.          SECTION 7.  The changes in law made by this Act apply only to   a plan year that commences on or after January 1, 2026. A plan year   that commenced 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 8.  This Act takes effect September 1, 2025.