TX HB1594

Group health benefit plans must cover early treatment for individuals under 26 years of age diagnosed with first episode psychosis, which includes initial onset of psychosis caused by medical/neurological conditions, serious mental illness, or substance use

Required coverage includes coordinated specialty care based on the National Institute of Mental Health's RAISE treatment model (psychotherapy, medication management, case management, family education/support, and education/employment support), assertive community treatment, and peer support services

Providers must contract with the Health and Human Services Commission and adhere to treatment model fidelity standards to qualify for required coverage; insurers must reimburse using a bundled payment model rather than fee-for-service

Texas Department of Insurance must convene a work group to develop medical necessity criteria and coding solutions, with recommendations due by January 1, 2026, and rules adopted by March 30, 2026

Coverage requirements may be waived for specific treatment models if an independent analysis (available upon insurer request starting March 1, 2027) finds premiums increased by more than 1% annually solely due to that coverage mandate