Bill Text: TX SB51 | 2021-2022 | 87th Legislature | Introduced


Bill Title: Relating to the requirement and study of insurance coverage for serious emotional disturbance of a child.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2021-02-09 - Co-author authorized [SB51 Detail]

Download: Texas-2021-SB51-Introduced.html
  87R663 MEW-F
 
  By: Zaffirini S.B. No. 51
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  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 or identified, as
  applicable, in a person who is at least three years of age and
  younger than 18 years of age by:
                           (i)  a physician licensed to practice
  medicine in this state and practicing within the scope of the
  physician's license; or
                           (ii)  a psychologist, licensed professional
  counselor, licensed marriage and family therapist, or licensed
  clinical social worker licensed to practice in this state and
  practicing within the scope of the applicable license; 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 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.
         (e)  Not later than August 1, 2022, 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, 2023.
         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 1355.054(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 as defined by
  Section 1355.001 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, 2022. A group health
  benefit plan that is delivered, issued for delivery, or renewed
  before January 1, 2022, 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, 2021.
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