Bill Text: TX HB1396 | 2025-2026 | 89th Legislature | Introduced

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Bill Title: Relating to coverage for mental health conditions and substance use disorders under certain governmental health benefit plans.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-11-19 - Filed [HB1396 Detail]

Download: Texas-2025-HB1396-Introduced.html

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By: Talarico H.B. No. 1396

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 1355.003(b), Insurance Code, is
repealed.
SECTION 7. 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 8. This Act takes effect September 1, 2025.