Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter P - MENTAL HEALTH PARITY
Division 1 - GENERAL PROVISIONS AND PARITY REQUIREMENTS
Section 21.2409 - Nonquantitative Treatment Limitations
Current through Reg. 50, No. 13; March 28, 2025
(a) General requirement. A health benefit plan may not impose a nonquantitative treatment limitation with respect to mental health or substance use disorder benefits in any classification unless, under the terms of the plan as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the nonquantitative treatment limitation to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation with respect to medical/surgical benefits in the classification.
(b) Illustrative list of nonquantitative treatment limitations. Nonquantitative treatment limitations include:
(c) Examples. The requirements of this section are illustrated by examples provided in figure 28 TAC § 21.2409(c). In each example, the health benefit plan is subject to the requirements of this section and provides both medical/surgical benefits and mental health and substance use disorder benefits.