HBA-ATS C.S.H.B. 1750 76(R)BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 1750
By: Van de Putte
Insurance
4/4/1999
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

Many insurers use utilization review agents to determine whether they
should pay for health care services provided to, or requested by, a
consumer.  In 1997, the Texas Department of Insurance adopted a rule that
prohibits a licensed utilization review agent from requiring, as a
condition of treatment approval, or for any other reason, the observation
of a psychotherapy session or the submission or review of a mental health
therapist's process or progress notes. 

C.S.H.B. 1750 prohibits a utilization review agent from requiring, as a
condition of treatment approval or for any other reason, the observation of
a psychotherapy session or the submission or review of a mental health
therapist's process or progress notes.  Under this bill, a utilization
review agent is authorized to require the submission of a patient's medical
record. 

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 Section 4, Article 21.58A, Insurance Code, by adding
Subsection (o), to prohibit a utilization review agent (agent) from
requiring, as a condition of treatment approval or for any other reason,
the observation of a psychotherapy session or the submission or review of a
mental health therapist's process or progress notes.  Authorizes an agent
to require the submission of a patient's medical record. 

SECTION 2.Effective date: September 1, 1999.
  Makes application of this Act prospective.

SECTION 3. Emergency clause.


COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 1750 deletes the text of the original bill relating to certain
mental health services provided under a health benefit plan and substitutes
it with provisions relating to standards for utilization review.  Under the
original bill, the proposed addition of Article 21.53S to the Insurance
Code would have prohibited an insurer from requiring, as a condition of
coverage or for any other reason, the observation of mental health
services, including services provided in a psychotherapy session, by a
representative of the insurer, or the submission, for review, of a mental
health care provider's process or progress notes to an insurer.  The
original bill would have also prohibited an insurer from denying benefits
for mental health services, including services provided in a psychotherapy
session, on the grounds that the enrollee refuses medication.  In addition,
the original bill would have prohibited an insurer from denying benefits
for mental health services on the grounds that the services are provided in
a group session with family members or other individuals. 

The substitute also modifies the original bill in SECTION 3 by providing
that the bill is effective September 1, 1999, rather than upon passage.