State RegulationsTX specificDifficulty 3/5
Under the Texas chemical dependency coverage statute, which of the following may a Texas health benefit plan do with respect to chemical dependency treatment?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under TIC 1368.005 the plan must cover treatment of chemical dependency, but it keeps its ordinary managed-care controls: medical necessity, treatment by appropriately licensed providers or facilities, utilization review, and cost sharing applied on the same terms used for other covered conditions. What it may not do is deny or eliminate the benefit because the underlying diagnosis happens to be a substance use disorder, which is precisely the discrimination the required-benefit provision addresses.
Why the other options are wrong
- A) Denying the claim solely because the diagnosis is a substance use disorder defeats the required benefit.
- B) Conditioning the benefit on an abstinence agreement adds an eligibility gate the statute does not authorize.
- C) Limiting the benefit to inpatient care removes a required component of treatment rather than managing it.
Memory hook
Manage the treatment; do not eliminate the benefit.