AACP Newsletter, Volume 12,
Number 4, Autumn 1998
Regional Reports:
Texas
The implementation of prior legislation passed in 1997 continues. This includes the Mental Health Parity Act. Some of the components are: Insurance companies are required to provide insurance deductibles, coverage amounts and co-pays that are the same as those provided for physical illnesses. It calls for coverage of 45 days of inpatient treatment, for 60 days of outpatient treatment and no lifetime limit on hospital days or outpatient visits. The definition of serious mental illness includes Schizophrenia and other Psychotic Disorders, Bipolar Disorder, Major Depressive Disorders, Schizoaffective Disorders, Obsessive-Compulsive Disorders and Depression in childhood and adolescence.
The Managed Care Reform bills allow for the correction of many of the managed care problems. New legislation holds HMO's proportionately liable for their negligent medical necessity decisions that result in harm to patients by obstructing needed care. Utilization reviewers should be providers who are qualified to provide the service that is being requested by the provider. Reimbursement shall be made to non-network physicians. Screening criteria must be based on accepted practices and a mechanism to ensure quality delivery shall be in place. These are just a few of the many changes resulting from the Managed Care legislation.
Attempts to ban ECT for persons 65 and older were not successful.
The Advance Directive stating the preferences or refusal for treatment by an adult who is not incapacitated has been recognized.
The Texas practitioners and consumers continue to monitor the Medicaid managed care initiatives that now affect over 300,000 Texans and which are expected to affect all Texas Medicaid recipients over the next four years.
Patricia Gomez-Carrion, MD
Continue to the Ohio Regional ReportContinue to the Texas Regional Report
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