Bill > SB636

This bill modifies Texas insurance law to expand coverage requirements for mental health conditions and substance use disorders across several government health benefit plans, including basic coverage plans under Chapters 1551 and 1601, basic plans under Chapter 1575, and primary care coverage plans under Chapter 1579. The bill removes a previous provision that allowed less extensive coverage for serious mental illness compared to physical illness, and instead ensures that these governmental health plans must provide equivalent coverage for mental health and substance use disorder treatments. The bill introduces new provisions requiring evaluation of both quantitative (measurable) and nonquantitative treatment limitations across categories like inpatient care, outpatient care, emergency care, and prescription drugs. For most plans, the Texas insurance commissioner will enforce these compliance requirements, while for specific plans, the applicable trustees or board of trustees will be responsible for enforcement. The changes will apply only to plan years starting on or after January 1, 2026, giving health plans time to adjust their coverage policies. The bill will take effect on September 1, 2025, representing a significant step toward ensuring more comprehensive mental health and substance use disorder coverage in governmental health benefit plans in Texas.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB636