HB 709 — Relating to the requirement and study of insurance coverage for serious emotional disturbance of a child.

Summary

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

Bill Text

Compared against the Texas statutes as published AI-generated reading aid — verify against the official bill.

This bill amends 3 section(s) of the Texas statutes: Section 1355.001, Insurance Code, Section 1355.0041, Insurance Code, Section 1355.054(a), Insurance Code.

• Section 1355.001, Insurance Code

  (5) "Serious emotional disturbance of a child" means a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders that results in functional impairment that substantially interferes with or limits a child's role or functioning in family, school, or community services 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 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 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 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 results in the person meeting state special education eligibility requirements for emotional disturbance.

  amended

• Section 1355.0041, Insurance Code

  Sec. 1355.0041. REQUIRED COVERAGE FOR SERIOUS EMOTIONAL DISTURBANCE OF A CHILD. (a) 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. (b) 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 (a)(1)(B); and (2) must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness. (c) 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. (d) Not later than December 1, 2026, 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 (c), together with any recommendations for legislation. (e) This subsection and Subsections (c) and (d) expire September 1, 2027.

  added

• or 1355.0041 or 1355.0041

  amended

• Section 1355.054(a), Insurance Code

  or serious emotional disturbance of a child as defined by Section 1355.001 or emotional disturbance

  amended

Action History

1. March 04, 2025

   Referred to Insurance

2. March 04, 2025

   Read first time

3. November 12, 2024

   Filed

Sponsors

• Senfronia Thompson · Primary

Subjects