Tex. Ins. Code Section 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.

Source: Section 1355.104 — Required Coverage for Treatment in Psychiatric Day Treatment Facility, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1355.­htm#1355.­104 (accessed Jun. 5, 2024).

1355.001
Definitions 1355.002
Applicability of Subchapter 1355.003
Exception 1355.004
Required Coverage for Serious Mental Illness 1355.005
Managed Care Plan Authorized 1355.006
Coverage for Certain Conditions Related to Controlled Substance or Marihuana Not Required 1355.007
Small Employer Coverage 1355.015
Required Coverage for Certain Enrollees 1355.051
Definitions 1355.052
Applicability of Subchapter 1355.053
Required Coverage for Certain Illnesses and Disorders 1355.054
Conditions for Coverage 1355.055
Determinations for Treatment in a Residential Treatment Center for Children and Adolescents 1355.056
Determinations for Treatment by a Crisis Stabilization Unit 1355.057
Review and Adjustment of Minimum Ratios of Reimbursement 1355.058
Health and Human Services Commission Assistance 1355.101
Definition 1355.102
Applicability of Subchapter 1355.103
Applicability of General Provisions of Other Law 1355.104
Required Coverage for Treatment in Psychiatric Day Treatment Facility 1355.105
Determinations for Treatment in Psychiatric Day Treatment Facility 1355.106
Offer of Coverage Required 1355.151
Prohibition on Exclusion or Limitation of Certain Coverages 1355.201
Applicability of General Provisions of Other Law 1355.202
Prohibition of Exclusion of Mental Health or Intellectual Disability Benefits for Treatment by Tax-supported Institution 1355.251
Definitions 1355.252
Applicability of Subchapter 1355.253
Exceptions 1355.254
Coverage for Mental Health Conditions and Substance Use Disorders 1355.255
Compliance 1355.256
Definitions Under Plan 1355.257
Coordination with Other Law 1355.258
Rules 1355.2571
Parity Complaint Portal 1355.2572
Educational Materials and Parity Law Training
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Accessed:
Jun. 5, 2024

§ 1355.104’s source at texas​.gov