The bill, S.B. No. 636, aims to enhance coverage for mental health conditions and substance use disorders under certain governmental health benefit plans in Texas. It amends various sections of the Insurance Code to clarify the applicability of specific subchapters to different types of health plans. Notably, it inserts provisions that explicitly include basic coverage plans under Chapters 1551, 1575, and 1601, as well as primary care coverage plans under Chapter 1579. Additionally, it specifies that certain existing laws do not apply to these plans, ensuring that they are subject to the new coverage requirements.

Furthermore, the bill introduces compliance measures for evaluating the benefits and coverage of health benefit plans concerning treatment limitations. It mandates that the commissioner and relevant trustees or boards enforce compliance by assessing both quantitative and nonquantitative treatment limitations across various care categories, including inpatient and outpatient care, emergency care, and prescription drugs. The changes will take effect for plan years commencing on or after January 1, 2026, with the law prior to this amendment continuing to govern earlier plan years.

Statutes affected:
Introduced: Insurance Code 1355.002, Insurance Code 1355.003, Insurance Code 1355.015, Insurance Code 1355.252, Insurance Code 1355.255 (Insurance Code 1355)