reglab/housing_qa huggingface dataset:
TX Ins Code § 1305.503 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle D - Provider Plans|Chapter 1305 - Workers' Compensation Health Care Networks|Subchapter K. Evaluation of Networks; Consumer Report Card|Section 1305.503. Confidentiality Requirements

Sec. 1305.503.  CONFIDENTIALITY REQUIREMENTS.  (a)  As necessary to implement this subchapter, the department may access information from an executive agency that is otherwise confidential under any law of this state, including the Texas Workers' Compensation Act.(b)  Confidential information provided to or obtained by the department under this section remains confidential and is not subject to disclosure under Chapter 552, Government Code.  The department may not release, and a person may not gain access to, any information that:(1)  could reasonably be expected to reveal the identity of an injured employee; or(2)  discloses provider discounts or differentials between payments and billed charges for individual providers or networks.(c)  Information that is in the possession of the department and that relates to an individual injured employee, and any compilation, report, or analysis produced from the information that identifies an individual injured employee, are not:(1)  subject to discovery, subpoena, or other means of legal compulsion for release to any person; or(2)  admissible in any civil, administrative, or criminal proceeding.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 4.02, eff. September 1, 2005.|
TX Ins Code § 1305.551 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle D - Provider Plans|Chapter 1305 - Workers' Compensation Health Care Networks|Subchapter L. Disciplinary Actions|Section 1305.551. Determination of Violation; Notice

Sec. 1305.551.  DETERMINATION OF VIOLATION; NOTICE.  (a)  If the commissioner determines that a network, insurance carrier, or any other person or third party operating under this chapter, including a third party to which a network delegates a function, or any third party with which a network contracts for management services, is in violation of this chapter, rules adopted by the commissioner under this chapter, or applicable provisions of the Labor Code or rules adopted under that code, the commissioner or a designated representative may notify the network, insurance carrier, person, or third party of the alleged violation and may compel the production of any documents or other information as necessary to determine whether the violation occurred.(b)  The commissioner's designated representative may initiate the proceedings under this section.(c)  A proceeding under this section is a contested case under Chapter 2001, Government Code.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 4.02, eff. September 1, 2005.|
TX Ins Code § 1305.552 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle D - Provider Plans|Chapter 1305 - Workers' Compensation Health Care Networks|Subchapter L. Disciplinary Actions|Section 1305.552. Disciplinary Actions

Sec. 1305.552.  DISCIPLINARY ACTIONS.  If under Section 1305.551 the commissioner determines that a network, insurance carrier, or other person or third party described under Section 1305.551 has violated or is violating this chapter, rules adopted by the commissioner under this chapter, or the Labor Code or rules adopted under that code, the commissioner may:(1)  suspend or revoke a certificate issued under this code;(2)  impose sanctions under Chapter 82;(3)  issue a cease and desist order under Chapter 83;(4)  impose administrative penalties under Chapter 84; or(5)  take any combination of these actions.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 4.02, eff. September 1, 2005.|
TX Ins Code § 1355.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.001. Definitions

Sec. 1355.001.  DEFINITIONS.  In this subchapter:(1)  "Serious mental illness" means the following psychiatric illnesses as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual (DSM):(A)  bipolar disorders (hypomanic, manic, depressive, and mixed);(B)  depression in childhood and adolescence;(C)  major depressive disorders (single episode or recurrent);(D)  obsessive-compulsive disorders;(E)  paranoid and other psychotic disorders;(F)   schizo-affective disorders (bipolar or depressive); and(G)  schizophrenia.(2)  "Small employer" has the meaning assigned by Section 1501.002.(3)  "Autism spectrum disorder" means a neurobiological disorder that includes autism, Asperger's syndrome, or Pervasive Developmental Disorder--Not Otherwise Specified.(4)  "Neurobiological disorder" means an illness of the nervous system caused by genetic, metabolic, or other biological factors.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 7, eff. September 1, 2007.|
TX Ins Code § 1355.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.002. Applicability of Subchapter

Sec. 1355.002.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies only to a group health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:(1)  a group insurance policy, group insurance agreement, group hospital service contract, or group evidence of coverage that is offered by:(A)  an insurance company;(B)  a group hospital service corporation operating under Chapter 842;(C)  a fraternal benefit society operating under Chapter 885;(D)  a stipulated premium company operating under Chapter 884; or(E)  a health maintenance organization operating under Chapter 843; and(2)  to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a plan offered under:(A)  a multiple employer welfare arrangement as defined by Section 3 of that Act; or(B)  another analogous benefit arrangement.(b)  Notwithstanding any provision in Chapter 1575 or 1579 or any other law, Section 1355.015 applies to:(1)  a basic plan under Chapter 1575; and(2)  a primary care coverage plan under Chapter 1579.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1107 (H.B. 451), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1355.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.003. Exception

Sec. 1355.003.  EXCEPTION.  (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(7)  a Medicare supplement benefit plan, as defined by Section 1652.002.(b)  For the purposes of a plan described by Subsection (a)(5), "serious mental illness" has the meaning assigned by Section 1355.001.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.004. Required Coverage for Serious Mental Illness

Sec. 1355.004.  REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS.  (a)  A group health benefit plan:(1)  must provide coverage, based on medical necessity, for not less than the following treatments of serious mental illness in each calendar year:(A)  45 days of inpatient treatment;  and(B)  60 visits for outpatient treatment, including group and individual outpatient treatment;(2)  may not include a lifetime limitation on the number of days of inpatient treatment or the number of visits for outpatient treatment covered under the plan;  and(3)  must include the same amount limitations, deductibles, copayments, and coinsurance factors for serious mental illness as the plan includes for physical illness.(b)  A group health benefit plan issuer:(1)  may not count an outpatient visit for medication management against the number of outpatient visits required to be covered under Subsection (a)(1)(B);  and(2)  must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.005. Managed Care Plan Authorized

Sec. 1355.005.  MANAGED CARE PLAN AUTHORIZED.  A group health benefit plan issuer may provide or offer coverage required by Section 1355.004 through a managed care plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.006. Coverage for Certain Conditions Related to Controlled Substance or Marihuana Not Required

Sec. 1355.006.  COVERAGE FOR CERTAIN CONDITIONS RELATED TO CONTROLLED SUBSTANCE OR MARIHUANA NOT REQUIRED.  (a)  In this section, "controlled substance" and "marihuana" have the meanings assigned by Section 481.002, Health and Safety Code.(b)  This subchapter does not require a group health benefit plan to provide coverage for the treatment of:(1)  addiction to a controlled substance or marihuana that is used in violation of law;  or(2)  mental illness that results from the use of a controlled substance or marihuana in violation of law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.007 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter A. Group Health Benefit Plan Coverage|Section 1355.007. Small Employer Coverage

Sec. 1355.007.  SMALL EMPLOYER COVERAGE.  An issuer of a group health benefit plan to a small employer must offer the coverage described by Section 1355.004 to the employer but is not required to provide the coverage if the employer rejects the coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.051. Definitions

Sec. 1355.051.  DEFINITIONS.  In this subchapter:(1)  "Crisis stabilization unit" means a 24-hour residential program that provides, usually for a short term, intensive supervision and highly structured activities to individuals who demonstrate a moderate to severe acute psychiatric crisis.(2)  "Individual treatment plan" means a treatment plan with specific attainable goals and objectives that are appropriate to:(A)  the patient;  and(B)  the program's treatment modality.(3)  "Residential treatment center for children and adolescents" means a child-care institution that:(A)  is accredited as a residential treatment center by:(i)  the Council on Accreditation;(ii)  the Joint Commission on Accreditation of Healthcare Organizations;  or(iii)  the American Association of Psychiatric Services for Children;  and(B)  provides residential care and treatment for emotionally disturbed children and adolescents.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.052. Applicability of Subchapter

Sec. 1355.052.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to a group health benefit plan that is delivered or issued for delivery in this state and that is:(1)  an accident and health insurance group policy;(2)  a group policy issued by a group hospital service corporation operating under Chapter 842;  or(3)  a group health care plan provided by a health maintenance organization operating under Chapter 843.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.053. Required Coverage for Certain Illnesses and Disorders

Sec. 1355.053.  REQUIRED COVERAGE FOR CERTAIN ILLNESSES AND DISORDERS.  A group health benefit plan that provides coverage for treatment of mental or emotional illness or disorder for a covered individual when the individual is confined in a hospital must also provide coverage for treatment in a residential treatment center for children and adolescents or a crisis stabilization unit that is at least as favorable as the coverage the plan provides for treatment of mental or emotional illness or disorder in a hospital.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.054. Conditions for Coverage

Sec. 1355.054.  CONDITIONS FOR COVERAGE.  (a)  Benefits of coverage provided under this subchapter may be used only in a situation in which:(1)  the covered individual has a serious mental illness that requires confinement of the individual in a hospital unless treatment is available through a residential treatment center for children and adolescents or a crisis stabilization unit;  and(2)  the covered individual's mental illness:(A)  substantially impairs the individual's thought, perception of reality, emotional process, or judgment;  or(B)  as manifested by the individual's recent disturbed behavior, grossly impairs the individual's behavior.(b)  The service for which benefits are to be paid from coverage provided under this subchapter must be:(1)  based on an individual treatment plan for the covered individual;  and(2)  provided by a service provider licensed or operated by the appropriate state agency to provide those services.(c)  Benefits under coverage provided under this subchapter are subject to the same benefit maximums, durational limitations, deductibles, and coinsurance factors that apply to inpatient psychiatric treatment under the coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.055 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.055. Determinations for Treatment in a Residential Treatment Center for Children and Adolescents

Sec. 1355.055.  DETERMINATIONS FOR TREATMENT IN A RESIDENTIAL TREATMENT CENTER FOR CHILDREN AND ADOLESCENTS.  (a)  Treatment in a residential treatment center for children and adolescents must be determined as if necessary care and treatment were inpatient care and treatment in a hospital. (b)  For the purposes of determining policy benefits and benefit maximums, each two days of treatment in a residential treatment center for children and adolescents is the equivalent of one day of treatment of mental or emotional illness or disorder in a hospital or inpatient program.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.056 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.056. Determinations for Treatment by a Crisis Stabilization Unit

Sec. 1355.056.  DETERMINATIONS FOR TREATMENT BY A CRISIS STABILIZATION UNIT.  (a)  Treatment by a crisis stabilization unit must be determined as if necessary care and treatment were inpatient care and treatment in a hospital.(b)  For the purposes of determining plan benefits and benefit maximums, each two days of treatment in a crisis stabilization unit is the equivalent of one day of treatment of mental or emotional illness or disorder in a hospital or inpatient program.(c)  Treatment provided to an individual by a crisis stabilization unit licensed or certified by the Texas Department of Mental Health and Mental Retardation shall be reimbursed.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.057 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.057. Review and Adjustment of Minimum Ratios of Reimbursement

Sec. 1355.057.  REVIEW AND ADJUSTMENT OF MINIMUM RATIOS OF REIMBURSEMENT.  (a)  The commissioner shall monitor and review the minimum ratios of reimbursement for alternative treatments required by Sections 1355.055 and 1355.056.(b)  If the commissioner finds that the limits provided by this subchapter are creating an artificial increase in the costs of services, the commissioner by rule may adjust the ratios to the extent necessary to prevent the artificial increase.(c)  Before the commissioner adjusts a ratio under Subsection (b), the commissioner must give notice and hold a hearing to:(1)  consider information related to the adjustment;  and(2)  determine whether the information justifies the adjustment.(d)  The department shall review the reimbursement ratios at least every two years.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.058 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter B. Alternative Mental Health Treatment Benefits|Section 1355.058. Assistance of the Texas Department of Mental Health and Mental Retardation

Sec. 1355.058.  ASSISTANCE OF THE TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION.  (a)  The Texas Department of Mental Health and Mental Retardation shall assist the department in carrying out the department's responsibilities under this subchapter.(b)  The department and the Texas Department of Mental Health and Mental Retardation by rule may adopt a memorandum of understanding to carry out this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter C. Psychiatric Day Treatment Facilities|Section 1355.101. Definition

Sec. 1355.101.  DEFINITION.  In this subchapter, "psychiatric day treatment facility" means a mental health facility that:(1)  provides treatment for individuals suffering from acute mental and nervous disorders in a structured psychiatric program using individualized treatment plans with specific attainable goals and objectives that are appropriate to the patient and the program's treatment modality;  and(2)  is clinically supervised by a doctor of medicine who is certified in psychiatry by the American Board of Psychiatry and Neurology.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter C. Psychiatric Day Treatment Facilities|Section 1355.102. Applicability of Subchapter

Sec. 1355.102.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to a group policy of accident and health insurance delivered or issued for delivery in this state, including a group policy issued by a group hospital service corporation operating under Chapter 842.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1355 - Benefits for Certain Mental Disorders|Subchapter C. Psychiatric Day Treatment Facilities|Section 1355.103. Applicability of General Provisions of Other Law

Sec. 1355.103.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW.  The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, construction of policies under that chapter, rulemaking under that chapter, and definitions of terms applicable in that chapter, apply to this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|