Bill Text: TX HB3891 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to coverage for eating disorders under certain health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-05-11 - Placed on General State Calendar [HB3891 Detail]
Download: Texas-2017-HB3891-Introduced.html
By: Coleman | H.B. No. 3891 |
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relating to coverage for eating disorders under certain health | ||
benefit plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1355.001, Insurance Code, is amended by | ||
adding Subdivisions (5) to read as follows: | ||
(5) "Eating disorder" means: | ||
(A) any eating disorder described by the | ||
Diagnostic and Statistical Manual of Mental Disorders, fifth | ||
edition, or a later edition adopted by the commissioner by rule, | ||
including: | ||
(i) anorexia nervosa; | ||
(ii) bulimia nervosa; | ||
(iii) binge eating disorder; | ||
(iv) rumination disorder; | ||
(v) avoidant/restrictive food intake | ||
disorder; or | ||
(vi) any eating disorder not otherwise | ||
specified; or | ||
(B) any eating disorder contained in a subsequent | ||
edition of the Diagnostic and Statistical Manual of Mental | ||
Disorders published by the American Psychiatric Association and | ||
adopted by the commissioner by rule. | ||
SECTION 2. Subchapter A, Chapter 1355, Insurance Code, is | ||
amended by adding Section 1355.008 to read as follows: | ||
Sec. 1355.008. REQUIRED COVERAGE FOR EATING DISORDERS. (a) | ||
A health benefit plan must provide coverage, based on medical | ||
necessity, for the diagnosis and treatment of an eating disorder. | ||
(b) Coverage required under Subsection (a) is limited to a | ||
service or medication, to the extent the service or medication is | ||
covered by the health benefit plan, ordered by a licensed | ||
physician, psychiatrist, psychologist, or therapist within the | ||
scope of the practitioner's license and in accordance with a | ||
treatment plan. | ||
(c) On request from the health benefit plan issuer, an | ||
eating disorder treatment plan must include all elements necessary | ||
for the issuer to pay a claim under the health benefit plan, which | ||
may include a diagnosis, goals, and proposed treatment by type, | ||
frequency, and duration. | ||
(d) Coverage required under Subsection (a) is not subject to | ||
a limit on the number of days of medically necessary treatment | ||
except as provided by the treatment plan. | ||
(e) A health benefit plan issuer may conduct a utilization | ||
review of an eating disorder treatment plan not more than once each | ||
six months unless the physician, psychiatrist, psychologist, or | ||
therapist treating the enrollee under the treatment plan agrees | ||
that a more frequent review is necessary. An agreement to conduct | ||
more frequent review under this subsection applies only to the | ||
enrollee who is the subject of the agreement. | ||
(f) A health benefit plan issuer shall pay any costs of | ||
conducting a utilization review of coverage required under | ||
Subsection (a) or obtaining a treatment plan. | ||
(g) In conducting a utilization review of treatment for an | ||
eating disorder, including review of medical necessity or the | ||
treatment plan, a utilization review agent shall consider: | ||
(1) the overall medical and mental health needs of the | ||
individual with the eating disorder; | ||
(2) factors in addition to weight; and | ||
(3) the most recent Practice Guideline for the | ||
Treatment of Patients with Eating Disorders adopted by the American | ||
Psychiatric Association. | ||
SECTION 3. 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, 2018. A health benefit plan that is | ||
delivered, issued for delivery, or renewed before January 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 4. This Act takes effect September 1, 2017. |