Bill Text: TX HB126 | 2017 | 85th Legislature 1st Special Session | Introduced
Bill Title: Relating to the requirement and study of insurance coverage for serious emotional disturbance of a child.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-07-24 - Referred to Insurance [HB126 Detail]
Download: Texas-2017-HB126-Introduced.html
85S10492 PMO-F | ||
By: Thompson of Harris | H.B. No. 126 |
|
||
|
||
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 18 years of age; and | ||
(B) meets at least one of the following criteria: | ||
(i) the disorder or condition 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 or condition 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 or condition 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 or condition results in | ||
the person meeting state special education eligibility | ||
requirements for emotional disturbance. | ||
SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is | ||
amended by adding Section 1355.0041 to read as follows: | ||
Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL | ||
DISTURBANCE OF A CHILD. (a) Notwithstanding Section 1355.002, | ||
this section does not apply to: | ||
(1) a basic plan under Chapter 1575; or | ||
(2) a primary care coverage plan under Chapter 1579. | ||
(b) A group health benefit plan: | ||
(1) must provide coverage for serious emotional | ||
disturbance of a child, based on medical necessity, for not less | ||
than the following treatments in each calendar year: | ||
(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 as the plan includes for physical | ||
illness. | ||
(c) A group health benefit plan issuer: | ||
(1) may not count an outpatient visit for medication | ||
management against the number of outpatient visits required to be | ||
covered under Subsection (b)(1)(B); and | ||
(2) must provide coverage for an outpatient visit | ||
described by Subsection (b)(1)(B) under the same terms as the | ||
coverage the issuer provides for an outpatient visit for the | ||
treatment of physical illness. | ||
(d) The department shall conduct a study to determine and | ||
evaluate the extent to which enrollees make 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. | ||
(e) Not later than August 1, 2018, 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 (d), together with any recommendations for | ||
legislation. | ||
(f) This subsection and Subsections (d) and (e) expire | ||
September 1, 2019. | ||
SECTION 3. Sections 1355.005 and 1355.007, Insurance Code, | ||
are amended to read as follows: | ||
Sec. 1355.005. MANAGED CARE PLAN AUTHORIZED. A group | ||
health benefit plan issuer may provide or offer coverage required | ||
by Section 1355.004 or 1355.0041 through a managed care plan. | ||
Sec. 1355.007. SMALL EMPLOYER COVERAGE. An issuer of a | ||
group health benefit plan to a small employer must offer the | ||
coverage described by Section 1355.004 or 1355.0041 to the employer | ||
but is not required to provide the coverage if the employer rejects | ||
the coverage. | ||
SECTION 4. Section 1355.051, Insurance Code, is amended by | ||
adding Subdivision (4) to read as follows: | ||
(4) "Serious emotional disturbance of a child" has the | ||
meaning assigned by Section 1355.001. | ||
SECTION 5. Section 1355.053, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1355.053. REQUIRED COVERAGE FOR CERTAIN ILLNESSES, | ||
[ |
||
provides coverage for treatment of mental or emotional illness or | ||
disorder or serious emotional disturbance of a child for a covered | ||
individual when the individual is confined in a hospital must also | ||
provide coverage for treatment in a residential treatment center | ||
for children and adolescents or a crisis stabilization unit that is | ||
at least as favorable as the coverage the plan provides for | ||
treatment of mental or emotional illness or disorder or serious | ||
emotional disturbance of a child in a hospital. | ||
SECTION 6. 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 7. 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 April 1, 2018. A group health | ||
benefit plan that is delivered, issued for delivery, or renewed | ||
before April 1, 2018, 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 December 1, 2017. |