Bill Text: TX HB1192 | 2011-2012 | 82nd Legislature | Comm Sub
Bill Title: Relating to the requirement and study of insurance coverage for serious emotional disturbance of a child.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2011-05-09 - Committee report sent to Calendars [HB1192 Detail]
Download: Texas-2011-HB1192-Comm_Sub.html
| 82R23118 PMO-F | |||
| By: Castro | H.B. No. 1192 | ||
| Substitute the following for H.B. No. 1192: | |||
| By: Eiland | C.S.H.B. No. 1192 | ||
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| relating to the requirement and study of insurance coverage for | ||
| serious emotional disturbance of a child. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Section 1355.001, Insurance Code, is amended by | ||
| adding Subdivision (5) to read as follows: | ||
| (5) "Serious emotional disturbance of a child" means | ||
| an emotional or behavioral disorder or a neuropsychiatric condition | ||
| that causes a person's functioning to be impaired in thought, | ||
| perception, affect, or behavior and that: | ||
| (A) has been diagnosed, by a physician licensed | ||
| to practice medicine in this state, a psychologist licensed to | ||
| practice in this state, or a licensed professional counselor | ||
| licensed to practice in this state, in a person who is at least | ||
| three years of age and younger than 17 years of age; and | ||
| (B) meets at least one of the following criteria: | ||
| (i) the disorder substantially impairs the | ||
| person's ability in at least two of the following activities or | ||
| tasks: | ||
| (a) self-care; | ||
| (b) engaging in family relationships; | ||
| (c) functioning in school; or | ||
| (d) functioning in the community; | ||
| (ii) the disorder creates a risk that the | ||
| person will be removed from the person's home and placed in a more | ||
| restrictive environment, including in a facility or program | ||
| operated by the Department of Family and Protective Services or an | ||
| agency that is part of the juvenile justice system; | ||
| (iii) the disorder causes the person to: | ||
| (a) display psychotic features or | ||
| violent behavior; or | ||
| (b) pose a danger to the person's self | ||
| or others; or | ||
| (iv) the disorder results in the person | ||
| meeting state special education eligibility requirements for | ||
| serious emotional disturbance. | ||
| SECTION 2. The heading to Section 1355.004, Insurance Code, | ||
| is amended to read as follows: | ||
| Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL | ||
| DISTURBANCE OF A CHILD AND SERIOUS MENTAL ILLNESS. | ||
| SECTION 3. Section 1355.004, Insurance Code, is amended by | ||
| amending Subsection (a) and adding Subsections (c), (d), and (e) to | ||
| read as follows: | ||
| (a) A group health benefit plan: | ||
| (1) must provide coverage for serious emotional | ||
| disturbance of a child diagnosed as described by Section | ||
| 1355.001(5) and coverage, based on medical necessity, for serious | ||
| mental illness for not less than the following treatments [ |
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| (A) 45 days of inpatient treatment; and | ||
| (B) 60 visits for outpatient treatment, | ||
| including group and individual outpatient treatment; | ||
| (2) may not include a lifetime limitation on the | ||
| number of days of inpatient treatment or the number of visits for | ||
| outpatient treatment covered under the plan; and | ||
| (3) must include the same amount limitations, | ||
| deductibles, copayments, and coinsurance factors for serious | ||
| emotional disturbance of a child and serious mental illness as the | ||
| plan includes for physical illness. | ||
| (c) The department shall conduct a study to determine and | ||
| evaluate the extent to which enrollees are making claims under | ||
| coverage for serious emotional disturbance of a child and the | ||
| impact, if any, the coverage for serious emotional disturbance of a | ||
| child and the claims have on the cost of the coverage for group | ||
| health benefit plans. | ||
| (d) Not later than August 1, 2012, the department shall | ||
| submit to the governor, the lieutenant governor, the speaker of the | ||
| house of representatives, and the appropriate standing committees | ||
| of the legislature a report regarding the results of the study | ||
| required by Subsection (c), together with any recommendations for | ||
| legislation. | ||
| (e) This subsection and Subsections (c) and (d) expire | ||
| September 1, 2013. | ||
| SECTION 4. Section 1355.054(a), Insurance Code, is amended | ||
| to read as follows: | ||
| (a) Benefits of coverage provided under this subchapter may | ||
| be used only in a situation in which: | ||
| (1) the covered individual has a serious mental | ||
| illness or serious emotional disturbance of a child that requires | ||
| confinement of the individual in a hospital unless treatment is | ||
| available through a residential treatment center for children and | ||
| adolescents or a crisis stabilization unit; and | ||
| (2) the covered individual's mental illness or | ||
| emotional disturbance: | ||
| (A) substantially impairs the individual's | ||
| thought, perception of reality, emotional process, or judgment; or | ||
| (B) as manifested by the individual's recent | ||
| disturbed behavior, grossly impairs the individual's behavior. | ||
| SECTION 5. The change in law made by this Act applies only | ||
| to a group health benefit plan that is delivered, issued for | ||
| delivery, or renewed on or after January 1, 2012. A group health | ||
| benefit plan that is delivered, issued for delivery, or renewed | ||
| before January 1, 2012, 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 6. This Act takes effect September 1, 2011. | ||
