Bill > HB1594

This bill requires group health benefit plans in Texas to provide coverage for early treatment of first episode psychosis for individuals under 26 years old. The bill defines first episode psychosis as the initial onset of psychosis symptoms caused by medical conditions, serious mental illness, or substance use. The coverage must include comprehensive services based on the Recovery After an Initial Schizophrenia Episode (RAISE) program, which encompasses psychotherapy, medication management, case management, family education and support, and employment support. The bill also mandates coverage for assertive community treatment and peer support services. Only treatment providers who adhere to specific treatment model fidelity and have contracted with the Health and Human Services Commission will be covered. The bill establishes a bundled payment model for reimbursement and requires the Texas Department of Insurance to convene a work group to develop medical necessity criteria and a coding solution for these services. The new requirements will take effect for health benefit plans delivered or renewed on or after March 30, 2026, with a provision that if independent analysis shows premiums increase by more than 1% due to these requirements, the specific treatment model coverage may be discontinued.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB1594