HBA-TBM C.S.H.B. 1491 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1491 By: Farabee Insurance 4/16/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Currently, many private insurance policies do not provide coverage for a child's mental illness that is comparable to the coverage provided for a physical illness. This can result in a mental illness in a child not being treated or discovered until the mental illness causes a physical ailment. Because of the limitations placed on mental health care reimbursements by insurers and a family's inability to pay the high cost of intensive private care, some children are forced into the public health care system. C.S.H.B. 1491 requires private health benefit plans to provide the same level of health care coverage for the mental health of a child that it provides for a child's physical health. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of insurance in SECTION 1 (Sections 1 and 6, Article 21.53R, Insurance Code) of this bill. ANALYSIS C.S.H.B. 1491 amends the Insurance Code to require a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness (plan) to provide coverage for certain mental disorders in children. The plan must provide coverage for an enrollee who is younger than 19 years of age for the diagnosis and treatment of a mental disorder under the same terms and conditions as coverage for diagnosis and treatment of physical illness. The bill authorizes the coverage to be provided or offered through a managed health care plan. The bill prohibits the coverage from being subject to an annual or lifetime limit on the number of days of inpatient treatment or the number of outpatient visits covered under the plan. The coverage provided must be subject to the same amount limits, deductibles, copayments, and coinsurance factors as coverage for physical illness. The bill requires the commissioner of insurance to adopt rules as necessary to implement these provisions. The bill requires the Sunset Advisory Commission to conduct a study, on or before September 1, 2006, of the extent of use and the impact on the cost of those health benefit plans of these provisions and report the findings to the legislature on or before January 1, 2007. EFFECTIVE DATE September 1, 2001. The Act applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2002. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1491 differs from the original by providing that "mental disorder" can be defined by an edition subsequent to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, adopted by rule by the commissioner of insurance. The substitute adds provisions requiring the Sunset Advisory Commission to study the impact of these provisions.