SB636 - Relating to coverage for mental health conditions and substance use disorders under certain governmental health benefit plans.

      By: Johnson  S.B. No. 636          (In the Senate - Filed December 18, 2024; February 3, 2025,   read first time and referred to Committee on Health & Human   Services; April 14, 2025, reported adversely, with favorable   Committee Substitute by the following vote:  Yeas 7, Nays 2;   April 14, 2025, sent to printer.) Click here to see the committee vote     COMMITTEE SUBSTITUTE FOR S.B. No. 636 By:  Hancock     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.  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 7.  Section 1355.003(b), Insurance Code, is   repealed.          SECTION 8.  The changes in law made by this Act apply only to   a plan year that commences on or after January 1, 2026. A plan year   that commenced 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 9.  This Act takes effect September 1, 2025.     * * * * *