Relating to insurance coverage for the treatment of eating disorders

This bill relates to insurance coverage for eating disorders. “Eating disorder” is defined in the bill as pica, rumination disorder, avoidant or restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder, and any other eating disorder contained in the most recent edition of the diagnostic and statistical manual of mental disorders as published by the American psychiatric association. The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for health care services (services) pursuant to a covered person’s treatment plan (plan), and services pursuant to a covered person’s plan that are provided to the covered person out-of-network or out-of-state if such services are unavailable in this state and are determined to be medically necessary by the covered person’s health care provider. “Treatment plan” is defined in the bill as a plan for the treatment of a covered person’s eating disorder developed by a health care professional pursuant to a comprehensive evaluation or reevaluation performed in consultation with the covered person or the covered person’s representative. The plan may include but is not limited to cognitive behavioral therapy, family-based therapy, group cognitive behavioral therapy, medical nutrition therapy, prescription drugs, hospitalization, day treatment programs, residential treatment programs, and other health care services. The bill applies to third-party payment providers enumerated in the bill, including the medical assistance program (program) under Code chapter 249A and managed care organizations acting pursuant to a contract with the department of health and human services to administer the program. The bill specifies the types of specialized health-related insurance which are not subject to the bill. The commissioner of insurance is required to adopt rules to administer the bill. The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026.