reglab/housing_qa huggingface dataset:
TX Ins Code § 1355.104 (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 1355.104. Required Coverage for Treatment in Psychiatric Day Treatment Facility

Sec. 1355.104.  REQUIRED COVERAGE FOR TREATMENT IN PSYCHIATRIC DAY TREATMENT FACILITY.  (a)  A group insurance policy that provides coverage for treatment of mental or emotional illness or disorder when an individual is confined in a hospital must also provide coverage for treatment obtained under the direction and continued medical supervision of a doctor of medicine or doctor of osteopathy in a psychiatric day treatment facility that provides organizational structure and individualized treatment plans separate from an inpatient program.(b)  The psychiatric day treatment facility coverage required by this section may not be less favorable than the hospital coverage and must be subject to the same durational limits, deductibles, and coinsurance factors.(c)  A group insurance policy subject to this section may require that:(1)  the treatment obtained in a psychiatric day treatment facility be provided by a facility that treats a patient for not more than 8 hours in any 24-hour period;(2)  the attending physician certify that the treatment is in lieu of hospitalization;  and(3)  the psychiatric day treatment facility be accredited by the Program for Psychiatric Facilities, or its successor, of the Joint Commission on Accreditation of Healthcare Organizations.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.105 (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 1355.105. Determinations for Treatment in Psychiatric Day Treatment Facility

Sec. 1355.105.  DETERMINATIONS FOR TREATMENT IN PSYCHIATRIC DAY TREATMENT FACILITY.  (a)  Benefits provided under this subchapter shall be determined as if necessary care and treatment in a psychiatric day treatment facility were inpatient care and treatment in a hospital.(b)  For the purpose of determining policy benefits and benefit maximums, each full day of treatment in a psychiatric day treatment facility is the equivalent of one-half 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 § 1355.106 (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 1355.106. Offer of Coverage Required; Alternative Benefits

Sec. 1355.106.  OFFER OF COVERAGE REQUIRED;  ALTERNATIVE BENEFITS.  (a)  An insurer shall offer, and a policyholder is entitled to reject, coverage under a group insurance policy for treatment of mental or emotional illness or disorder when confined in a hospital or in a psychiatric day treatment facility.(b)  A policyholder may select an alternative level of benefits under the group insurance policy if the alternative level is offered by or negotiated with the insurer.(c)  The alternative level of benefits must provide policy benefits and benefit maximums for treatment in a psychiatric day treatment facility equal to at least one-half of that provided for treatment in a hospital, except that benefits for treatment in a psychiatric day treatment facility may not exceed the usual and customary charges of the facility.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.151 (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 D. Certain Coverages Provided by Local Governments|Section 1355.151. Prohibition on Exclusion or Limitation of Certain Coverages

Sec. 1355.151.  PROHIBITION ON EXCLUSION OR LIMITATION OF CERTAIN COVERAGES.  (a)  In this section, "serious mental illness" has the meaning assigned by Section 1355.001.(b)  A political subdivision that provides group health insurance coverage, health maintenance organization coverage, or self-insured health care coverage to the political subdivision's officers or employees may not contract for or provide coverage that is less extensive for serious mental illness than the coverage provided for any other physical illness.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.201 (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 E. Benefits for Treatment by Tax-Supported Institution|Section 1355.201. Applicability of General Provisions of Other Law

Sec. 1355.201.  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.|
TX Ins Code § 1355.202 (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 E. Benefits for Treatment by Tax-Supported Institution|Section 1355.202. Prohibition of Exclusion of Mental Health or Mental Retardation Benefits for Treatment by Tax-Supported Institution

Sec. 1355.202.  PROHIBITION OF EXCLUSION OF MENTAL HEALTH OR MENTAL RETARDATION BENEFITS FOR TREATMENT BY TAX-SUPPORTED INSTITUTION.  (a)  An individual or group accident and health insurance policy delivered or issued for delivery to a person in this state that provides coverage for mental illness or mental retardation may not exclude benefits under that coverage for support, maintenance, and treatment provided by a tax-supported institution of this state, or by a community center for mental health or mental retardation services, that regularly and customarily charges patients who are not indigent for those services.(b)  In determining whether a patient is not indigent, as provided by Subchapter B, Chapter 552, Health and Safety Code, a tax-supported institution of this state or a community center for mental health or mental retardation services shall consider any insurance policy or policies that provide coverage to the patient for mental illness or mental retardation.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1355.251 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.251. Definitions

Sec. 1355.251.  DEFINITIONS.  In this subchapter:(1)  "Mental health benefit" means a benefit relating to an item or service for a mental health condition, as defined under the terms of a health benefit plan and in accordance with applicable federal and state law.(2)  "Nonquantitative treatment limitation" means a limit on the scope or duration of treatment that is not expressed numerically.  The term includes:(A)  a medical management standard limiting or excluding benefits based on medical necessity or medical appropriateness or based on whether a treatment is experimental or investigational;(B)  formulary design for prescription drugs;(C)  network tier design;(D)  a standard for provider participation in a network, including reimbursement rates;(E)  a method used by a health benefit plan to determine usual, customary, and reasonable charges;(F)  a step therapy protocol;(G)  an exclusion based on failure to complete a course of treatment; and(H)  a restriction based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of a benefit.(3)  "Quantitative treatment limitation" means a treatment limitation that determines whether, or to what extent, benefits are provided based on an accumulated amount such as an annual or lifetime limit on days of coverage or number of visits.  The term includes a deductible, a copayment, coinsurance, or another out-of-pocket expense or annual or lifetime limit, or another financial requirement.(4)  "Substance use disorder benefit" means a benefit relating to an item or service for a substance use disorder, as defined under the terms of a health benefit plan and in accordance with applicable federal and state law.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.252 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.252. Applicability of Subchapter

Sec. 1355.252.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies only to a health benefit plan that provides benefits or coverage for medical or surgical expenses incurred as a result of a health condition, accident, or sickness and for treatment expenses incurred as a result of a mental health condition or substance use disorder, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, an individual or group evidence of coverage, or a similar coverage document, that is offered by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a fraternal benefit society operating under Chapter 885;(4)  a stipulated premium company operating under Chapter 884;(5)  a health maintenance organization operating under Chapter 843;(6)  a reciprocal exchange operating under Chapter 942;(7)  a Lloyd's plan operating under Chapter 941;(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or(9)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846.(b)  Notwithstanding Section 1501.251 or any other law, this subchapter applies to coverage under a small employer health benefit plan subject to Chapter 1501.(c)  This subchapter applies to a standard health benefit plan issued under Chapter 1507.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.253 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.253. Exceptions

Sec. 1355.253.  EXCEPTIONS.  (a)  This subchapter does not apply to:(1)  a plan that provides coverage:(A)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(B)  as a supplement to a liability insurance policy;(C)  for credit insurance;(D)  only for dental or vision care;(E)  only for hospital expenses;(F)  only for indemnity for hospital confinement; or(G)  only for accidents;(2)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss(g)(1));(3)  a workers' compensation insurance policy;(4)  medical payment insurance coverage provided under a motor vehicle insurance policy; or(5)  a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1355.252.(b)  To the extent that this section would otherwise require this state to make a payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 C.F.R. Section 155.20, is not required to provide a benefit under this subchapter that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.254 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.254. Coverage for Mental Health Conditions and Substance Use Disorders

Sec. 1355.254.  COVERAGE FOR MENTAL HEALTH CONDITIONS AND SUBSTANCE USE DISORDERS.  (a)  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.(b)  Coverage under Subsection (a) 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 quantitative or nonquantitative treatment limitations imposed on coverage of benefits for medical or surgical expenses.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.255 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.255. Compliance

Sec. 1355.255.  COMPLIANCE.  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.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.256 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.256. Definitions Under Plan

Sec. 1355.256.  DEFINITIONS UNDER PLAN.  (a)  A health benefit plan must define a condition to be a mental health condition or not a mental health condition in a manner consistent with generally recognized independent standards of medical practice.(b)  A health benefit plan must define a condition to be a substance use disorder or not a substance use disorder in a manner consistent with generally recognized independent standards of medical practice.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.257 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.257. Coordination With Other Law; Intent of Legislature

Sec. 1355.257.  COORDINATION WITH OTHER LAW; INTENT OF LEGISLATURE.  This subchapter supplements Subchapters A and B of this chapter and Chapter 1368 and the department rules adopted under those statutes.  It is the intent of the legislature that Subchapter A or B of this chapter or Chapter 1368 or a department rule adopted under those statutes controls in any circumstance in which that other law requires:(1)  a benefit that is not required by this subchapter; or(2)  a more extensive benefit than is required by this subchapter.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1355.2571 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.2571. Parity Complaint Portal

Sec. 1355.2571.  PARITY COMPLAINT PORTAL.  (a) The commissioner shall develop and maintain a parity complaint portal that is an integrated system that allows for the enrollee of a health benefit plan to submit complaints of suspected violations of the provisions of this subchapter. The parity complaint portal must:(1)  allow for an enrollee to submit a complaint through multiple ways;(2)  provide updates on the status of an enrollee's complaint;(3)  ensure timely, effective, and equitable resolution for submitted complaints;(4)  include educational materials regarding:(A)  benefits for mental health conditions and substance use disorders required under this subchapter;(B)  an enrollee's rights and responsibilities under a health benefit plan concerning coverage under this subchapter;(C)  circumstances under which a claim may be denied; and(D)  the processes for reviewing a complaint submitted through the portal;(5)  adhere to national best practices as determined by the commissioner; and(6)  include the findings of the report required by Section 1355.2572(b).(b)  In developing the parity complaint portal under Subsection (a), the commissioner:(1)  shall conduct an assessment of complaint portals and similar systems used by other relevant public or private entities;(2)  shall develop best practice standards for complaint submissions and tracking consistent with the findings of the assessment conducted under Subdivision (1); and(3)  may develop a new complaint portal or modify an existing complaint portal.(c)  The Health and Human Services Commission shall appoint a liaison to the department to receive reports of concerns, complaints, and potential violations submitted through the parity complaint portal established under Subsection (a).|Added by Acts 2021, 87th Leg., R.S., Ch. 703 (H.B. 2595), Sec. 2, eff. September 1, 2021.|
TX Ins Code § 1355.2572 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.2572. Educational Materials and Parity Law Training; Report

Sec. 1355.2572.  EDUCATIONAL MATERIALS AND PARITY LAW TRAINING; REPORT.  (a) The commissioner, in collaboration with the Health and Human Services Commission's ombudsman for behavioral health, shall develop educational materials and parity law training sessions regarding the coverage for mental health conditions and substance use disorders required under this subchapter. The commissioner shall ensure that the materials and training sessions:(1)  are available to health benefit plan issuers and enrollees;(2)  include online, print, and in-person formats;(3)  are made available through the parity complaint portal established under Section 1355.2571 and at relevant locations and settings, including:(A)  any relevant agency offices;(B)  health benefit plan provider service locations; and(C)  relevant professional conferences and trade association meetings;  and(4)  include a list of relevant third-party organization educational and parity law awareness materials that provide additional information regarding mental health conditions and substance use disorder parity and, if provided in an online format, provide the links needed to access those materials online.(b)  Not later than September 1 of each year, the commissioner, in collaboration with the Health and Human Services Commission's ombudsman for behavioral health, shall:(1)  prepare and submit a report to the appropriate committees of the legislature and the appropriate state agencies on the status of:(A)  rights and responsibilities for mental health condition and substance use disorder benefits; and(B)  resolved and unresolved complaints submitted through the parity complaint portal established under Section 1355.2571(a); and(2)  publish the findings of the report under Subdivision (1) to the parity complaint portal established under Section 1355.2571(a).|Added by Acts 2021, 87th Leg., R.S., Ch. 703 (H.B. 2595), Sec. 2, eff. September 1, 2021.|
TX Ins Code § 1355.258 (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 F. Coverage for Mental Health Conditions and Substance Use Disorders|Section 1355.258. Rules

Sec. 1355.258.  RULES.  The commissioner shall adopt rules necessary to implement this subchapter.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1357.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1357 - Mastectomy|Subchapter A. Reconstructive Surgery Following Mastectomy|Section 1357.001. Definitions

Sec. 1357.001.  DEFINITIONS.  In this subchapter:(1)  "Breast reconstruction" means reconstruction of a breast incident to mastectomy to restore or achieve breast symmetry.  The term includes surgical reconstruction of a breast on which mastectomy has been performed and surgical reconstruction of a breast on which mastectomy has not been performed.(2)  "Enrollee" means an individual entitled to coverage under a health benefit plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1357.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1357 - Mastectomy|Subchapter A. Reconstructive Surgery Following Mastectomy|Section 1357.002. Applicability of Subchapter

Sec. 1357.002.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a fraternal benefit society operating under Chapter 885;(4)  a stipulated premium company operating under Chapter 884;(5)  a reciprocal exchange operating under Chapter 942;(6)  a health maintenance organization operating under Chapter 843;(7)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;  or(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|