Definition


View in Glossary

Legislation Signed into Law

2017-2018

Primary Focus Parity Enforcement
Title/Description An Act Relating to Access and Benefits for Mental Health Conditions and Substance Use Disorders
Citation Tex. Gov’t Code Ann. §§ 531.02251
Citation 531.02252
Summary

Tex. Gov’t Code Ann. §§ 531.02251, 531.02252 established an ombudsman and parity work group to help consumers and providers resolve behavioral health care access issues and increase compliance with parity laws. Specifically, the Health and Human Services Commission shall:
(1) Identify an ombudsman to help consumers encountering obstacles when accessing behavioral health services to file the appropriate complaint for both Medicaid-CHIP and for private insurance;
(2) Create a central location with designated staff to improve consumer assistance to Texans who encounter mental health parity violations;
(3) Create a stakeholder workgroup to develop a strategy for successful compliance with parity laws which shall convene quarterly through September 1, 2021;
(4) Collect data for Medicaid and Managed Care plans related to non-quantitative treatment limitations in accessing mental health and substance use treatment.

Moreover, the Act instructs the Texas Department of Insurance to:
(1) Expand parity enforcement beyond qualitative treatment limitations, such as visit limits and copays, and to address mental health and substance use disorder service complaints that are non-qualitative in nature, such as reviews for medical necessity;
(2) More widely enforce the requirements of federal parity law and regulations for all health insurance plans regulated by the state for plans issued or renewed on or after January 1, 2018;
(3) Collect data related to non-qualitative treatment limitations in accessing behavioral health services for all health insurance plans regulated by the state in order to inform insurers, agencies, and legislators of consumer experiences when accessing behavioral health care.

Effective Date September 1, 2017
Notes

Enacted by HB 10, which created Tex. Gov’t Code Ann. §§ 531.02251, 531.02252.

Primary Focus Mandated Benefit: Provider
Title/Description Coverage for Maternal Depression Screening
Citation Tex. Health & Safety Code § 62.1511
Summary

The covered services under the child health plan must include a maternal depression screening for an enrollee’s mother.

Effective Date September 1, 2017
Notes

Enacted through HB 2466 (85th Regular session)

Primary Focus Mandated Benefit: Provider
Title/Description Coverage for Mental Health Conditions and Substance Use Disorders
Citation Tex. Ins. Code § 1355.254
Summary

A health benefit plan must provide benefits and coverage for mental health conditions and substance use disorders under the same terms and conditions applicable to the plan’s medical and surgical benefits and coverage. Coverage may not impose quantitative or nonquantitative treatment limitations on benefits for a mental health condition or substance use disorder that are generally more restrictive than those imposed on coverage for medical or surgical expenses.

Effective Date September 1, 2017 per Tex. SB 769.
Notes

Enacted through HB 10 (85th Regular Session)

HB.10
Introduced 02/2017
Sponsor Reps. Price, Greg Bonnen, Coleman, Munoz Jr., and Rose
Status Signed into law 6/2017
Summary

This bill changed the section of the state insurance law relevant to parity by adding several new sections to the law, creating an ombudsman for behavioral health access to care, and by creating a state parity working group. The new sections of the law add requirements that are very similar to the final regulations of the Federal Parity Law. This is important because currently, the Texas Department of Insurance does not have the authority to enforce the Federal Parity Law. These requirements entail the following:

  • Behavioral health coverage must be on the same terms and conditions as coverage for other medical conditions, generally speaking
  • Quantitative treatment limitations and non-quantitative treatment limitations on behavioral health coverage must be “no more restrictive” than those in place for other medical coverage
  • Health plans must define conditions as a mental health condition or not a mental health condition in a manner that is consistent with generally recognized independent standards of medical practice
  • Health plans must define conditions as a substance use disorder or not a substance use disorder in a manner that is consistent with generally recognized independent standards of medical practice

These new sections also require the Texas Insurance must also “collect and compare” data from health plans about behavioral health coverage and other medical coverage regarding:

  • Prior authorization and other utilization review
  • Denials based on medical necessity or because a treatment is experimental or investigational
  • Internal appeals and whether internal appeals were denied
  • External reviews including data that indicates whether the appeal was upheld

The new sections also require the state Health and Human Services Commission to collect the same data from Medicaid managed care organizations.

2013-2014

Primary Focus Medicaid
Title/Description Behavioral Health and Physician Health Services Network
Citation Tex. Gov’t Code § 533.00255
Summary

The commission shall, to the greatest extent possible, integrate into the Medicaid managed care program implemented under this chapter the following services for Medicaid-eligible persons:
(1) behavioral health services, including targeted case management and psychiatric rehabilitation services; and (2) physical health services.

Effective Date June 14, 2013
Notes

Enacted through SB 58 ( 83rd Regular Session)

HB.3276
Introduced 03/2013
Sponsor Rep. Deuell
Status Signed into law 6/2014
Summary

This bill changed the section of the state insurance law relevant to parity so that individual plans,small employer fully-insured plans, and large employer fully-insured plans are required to screen for autism spectrum disorders. It also specified that professionals who are working under the supervision of qualified providers may provide services for treatment of autism.
This bill also makes clear that it does not apply to qualified health plans if it is determined that complying with the provisions of this bill would require a qualified health plan to exceed the requirements of essential health benefits required by the Affordable Care Act.

SB.1484
Introduced 03/2013
Sponsor Sen. Watson, Sen. Davis, Sen. Lucio
Status Signed into law 6/2014
Summary

This bill changed the section of the state insurance law relevant to parity so that individual plans,small employer fully-insured plans, and large employer fully-insured plans are required to provide coverage for generally recognized services for autism spectrum disorder for children beyond their tenth birthdays. Prior to this bill becoming law, insurers were only required to cover autism spectrum disorder treatment through age nine.

HB.451
Introduced 12/2008
Sponsor 12/2008
Sponsor Rep. Lucio
Status Signed into law 07/2009
Summary

This bill amended the autism section of the Insurance Code to require health plans provide coverage for enrollees from the date of diagnosis through age 9. Previously, coverage had only been required through age 6.

National Parity Map

View the state parity reports to learn about legislation, regulation, and litigation related to parity implementation

National Parity Map

Get Support

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.