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89(R) HB 1142 - Engrossed version - Bill Text
By: Oliverson, Lambert, Plesa, Lozano,
H.B. No. 1142
et al.
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. Sections 1368.002, 1368.003, and 1368.004,
Insurance Code, are amended to read as follows:
Sec. 1368.002. APPLICABILITY OF CHAPTER.
(a)
This chapter
applies only to a [
group
] health benefit plan that provides
hospital and medical coverage or services on an expense incurred,
service, or prepaid basis, including
an individual or
a group
insurance policy or contract or self-funded or self-insured plan or
arrangement that is offered in this state by:
(1) an insurer;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843; or
(4) an employer, trustee, or other self-funded or
self-insured plan or arrangement.
(b) Notwithstanding any other law, this chapter 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;
or
(4)
a plan providing basic coverage under Chapter
1601.
Sec. 1368.003. EXCEPTION. This chapter does not apply to:
(1) [
an employer, trustee, or other self-funded or
self-insured plan or arrangement with 250 or fewer employees or
members;
[
(2) an individual insurance policy;
[
(3)
an individual evidence of coverage issued by a
health maintenance organization;
[
(4)
] a health insurance policy that provides only:
(A) cash indemnity for hospital or other
confinement benefits;
(B) supplemental or limited benefit coverage;
(C) coverage for specified diseases or
accidents;
(D) disability income coverage; or
(E) any combination of those benefits or
coverages;
(2)
[
(5)
] a blanket insurance policy;
(3)
[
(6)
] a short-term travel insurance policy;
(4)
[
(7)
] an accident-only insurance policy;
(5)
[
(8)
] a limited or specified disease insurance
policy;
(6)
[
(9)
] an individual conversion insurance policy
or contract;
(7)
[
(10)
] a policy or contract designed for issuance
to a person eligible for Medicare coverage or other similar
coverage under a state or federal government plan; or
(8)
[
(11)
] an evidence of coverage provided by a
health maintenance organization if the plan holder is the subject
of a collective bargaining agreement that was in effect on January
1, 1982, and that has not expired since that date.
Sec. 1368.004. COVERAGE REQUIRED. (a) A [
group
] health
benefit plan shall provide coverage for the necessary care and
treatment of chemical dependency.
(b) Coverage required under this section may be provided:
(1) directly by the [
group
] health benefit plan
issuer; or
(2) by another entity, including a single service
health maintenance organization, under contract with the [
group
]
health benefit plan issuer.
SECTION 7. Section 1368.005(a), Insurance Code, is amended
to read as follows:
(a)
Coverage
[
Except as provided by Subsection (b),
coverage
] required under this chapter[
:
[
(1)
] may not be less favorable than coverage provided
for physical illness generally under the plan[
; and
[
(2)
shall be subject to the same durational limits,
dollar limits, deductibles, and coinsurance factors that apply to
coverage provided for physical illness generally under the plan
].
SECTION 8. The heading to Section 1368.006, Insurance Code,
is amended to read as follows:
Sec. 1368.006.
LIFETIME
LIMITATION ON COVERAGE
PROHIBITED
.
SECTION 9. Section 1368.006(b), Insurance Code, is amended
to read as follows:
(b)
Coverage
[
Notwithstanding Section 1368.005, coverage
]
required under this chapter
may not be subject
[
is limited
] to a
lifetime maximum [
of three separate treatment series for each
covered individual
].
SECTION 10. Section 1551.205, Insurance Code, is amended to
read as follows:
Sec. 1551.205. LIMITATIONS. The board of trustees may not
contract for or provide a coverage plan that:
(1) excludes or limits coverage or services for
acquired immune deficiency syndrome, as defined by the Centers for
Disease Control and Prevention of the United States Public Health
Service, or human immunodeficiency virus infection;
or
(2) [
provides coverage for serious mental illness that
is less extensive than the coverage provided for any physical
illness; or
[
(3)
] may provide coverage for prescription drugs to
assist in stopping smoking at a lower benefit level than is provided
for other prescription drugs.
SECTION 11. Section 1355.003(b), Insurance Code, is
repealed.
SECTION 12. Sections 1368.005(b) and 1368.006(a),
Insurance Code, are repealed.
SECTION 13. 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, 2026. A health benefit plan
delivered, issued for delivery, or renewed 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 14. This Act takes effect September 1, 2025.