Section 21.2404 - Differences from Federal Rules(a) Global substitution of terms. This subchapter substitutes the following terms for terms used in 45 CFR § 146.136 (concerning Parity in Mental Health and Substance Use Disorder Benefits) with no change in meaning: (1) the term "enrollees" is substituted for the term "participants and beneficiaries";(2) the term "health benefit plan" is substituted for the terms "group health plan" (or health insurance coverage offered in connection with such plans) and "plan or coverage"; and(3) the terms "requirement" or "requirements" are substituted for the terms "rule" or "rules."(b) Omission of federal provisions. The following federal provisions are not duplicated in this division either because they were superseded by a later federal rule or there is no analogous Texas law, or because they are otherwise captured in this subchapter: (1)45 CFR § 146.136(b)(1)(ii), which addresses exemptions;(2)45 CFR § 146.136(c)(5), which addresses exemptions;(3)45 CFR § 146.136(f), which addresses small employer exemption; and(4)45 CFR § 146.136(g), which addresses increased cost exemption.(c) Substitutions for federal provisions. Where a state requirement exists, a corresponding but incongruent federal provision has been omitted. Specifically, § 21.2411 of this title (relating to Availability of Plan Information) replaces the federal provision at 45 CFR § 146.136(d)(2), which addresses reason for any denial. In addition, a portion of 45 CFR § 146.136(d)(3), which addresses provisions of other law, has been omitted.28 Tex. Admin. Code § 21.2404
The provisions of this §21.2404 adopted to be effective January 31, 1999, 24 TexReg 393; amended to be effective March 2, 2011, 36 TexReg 1291; Adopted by Texas Register, Volume 46, Number 36, September 3, 2021, TexReg 5579, eff. 9/7/2021