HBA-ATS H.B. 1406 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1406
By: Coleman
Insurance
3/2/1999
Introduced



BACKGROUND AND PURPOSE 

In 1997, the Texas Legislature amended Article 3.51-14, Insurance Code, by
expanding the definition of "serious mental illness" and requiring certain
health maintenance organizations and group insurance plans to provide
coverage for the medical treatment of serious mental illness.  In addition,
minimum requirements were established for inpatient and outpatient
treatment coverage, with plans being prohibited from including a lifetime
limit on these restrictions.  Although Article 3.51-14 applies to both
adults and children, children face mental health issues unique to them.  In
children, mental disorders impair the ability to learn, to develop normal
peer relationships, and to function in a family.  Moreover, the various
developmental stages of children can mask the symptoms of mental disorders.

H.B. 1406 creates a separate statutory provision tailored to children
younger than age 19.  It expands the definition of "serious mental illness"
from that found in Article 3.51-14, Insurance Code, and it amends Article
3.51.14, Insurance Code, by deleting depression in childhood and
adolescence from the list of psychiatric illnesses that constitute a
"serious mental illness."  In addition, this bill provides that a child
does not suffer from a serious mental illness solely because the child has
mental retardation or epilepsy, commits alcohol or substance abuse or
experiences a brief period of intoxication, or commits criminal or
delinquent acts.  Like Article 3.51.14, this bill requires certain health
maintenance organizations and group insurance plans to provide coverage for
the medical treatment of serious mental illness, and it establishes minimum
requirements for inpatient and outpatient treatment coverage, with plans
being prohibited from including a lifetime limit on these restrictions. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter E, Chapter 21, Insurance Code, by adding
Article 21.53R, as follows: 

Art. 21.53R.  COVERAGE FOR CERTAIN SERIOUS MENTAL ILLNESSES IN CHILDREN

Sec. 1.  DEFINITIONS.  Defines "child," "health benefit plan," and "serious
mental illness." For purposes of this article, a "serious mental illness"
includes depression, schizophrenia, paranoia, bipolar disorders, major
depressive disorders, schizo-affective disorders, pervasive developmental
disorders, obsessive-compulsive disorders, and other psychotic disorders.
Also included within the definition is a diagnosable behavioral or
emotional disorder or a neuropsychiatric condition that satisfies three
conditions.  First, it results in a serious disability requiring sustained
treatment interventions.  Second, it is of sufficient duration to meet
diagnostic criteria specified in the American Psychiatric Association's
Diagnostic and Statistical Manual designated as DSM-IV-R. Third, it impairs
the thought, perception, affect, or behavior of a person, substantially
interfering with or limiting the person's role or functioning in the
person's community, school, family, or peer group. 
 
Sec. 2.  SCOPE OF ARTICLE.  (a) Specifies that Article 21.53R applies only
to a comprehensive health benefit  plan that provides benefits for medical
or surgical expenses incurred because of a health condition, accident, or
sickness.  These types of plans include an individual, group, blanket, or
franchise insurance policy or insurance agreement.  Also included is
individual or group coverage offered by an insurance company; a group
hospital service corporation; a fraternal benefit society; a stipulated
premium insurance company; a reciprocal exchange; a health maintenance
organization; a small employer carrier; a multiple employer welfare
arrangement; or an approved nonprofit health corporation. 

(b) Provides that Article 21.53R does not apply to a plan that provides
coverage only for a specific disease or other limited benefit; only for
accidental death or dismemberment; for wages or payments for a period
during which an employee is absent from work because of sickness or injury;
as a supplement to liability insurance; for credit insurance; only for
dental or vision care; only for hospital expenses; or only for indemnity
for hospital confinement.  Also excluded is a Medicare supplemental policy;
workers' compensation insurance coverage; medical payment insurance
coverage issued as part of a motor vehicle insurance policy; or a long-term
care policy. 

Sec. 3.  REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESSES IN CHILDREN. (a)
Sets forth that a health benefit plan (plan) must provide coverage for a
child enrollee for 45 days of inpatient treatment and 60 visits for
outpatient treatment, including group and individual outpatient treatment,
in each calendar year.  Prohibits a plan from including a lifetime limit on
the number of days of inpatient treatment or the number of outpatient
visits covered under the plan.  Provides that a plan must include the same
amount limits, deductibles, and coinsurance factors for serious mental
illness as for physical illness. 

(b) Prohibits an issuer of a plan from counting toward the number of
outpatient visits required to be covered under Subsection (a) of this
section an outpatient visit for the purpose of medication management.
Provides that an issuer of a plan must cover an outpatient visit for the
purpose of medication management under the same terms and conditions as it
covers outpatient visits for treatment of physical illness. 

(c) Authorizes an issuer of a plan to provide or offer coverage required
under this section through another plan that is a managed care plan. 

Sec. 4.  CERTAIN CONDITIONS EXCLUDED.  Provides that a child does not
suffer from a serious mental illness solely because the child has mental
retardation or epilepsy, commits alcohol or substance abuse or experiences
a brief period of intoxication, or commits criminal or delinquent acts. 

SECTION 2.  Amends Section 1(1), Article 3.51-14, Insurance Code, by
deleting depression in childhood and adolescence from the list of
psychiatric illnesses which constitute a "serious mental illness."  Makes a
conforming change. 

SECTION 3.  Amends Article 3.51-14, Insurance Code, by adding Section 6, to
provide that this article does not apply to an enrollee younger than age
19. 

SECTION 4.  Effective date: September 1, 1999.

SECTION 5.  Makes application of this Act prospective for health benefit
plans that are delivered, issued for delivery, or renewed on or after
January 1, 2000. 

SECTION 6.  Emergency clause.