88R7283 JES-D
 
  By: LaMantia S.B. No. 2176
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit plan coverage for treatment of autism.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1355.001(3), Insurance Code, is amended
  to read as follows:
               (3)  "Autism spectrum disorder" means:
                     (A)  a neurobiological disorder or developmental
  disability that significantly affects verbal communication,
  nonverbal communication, and social interaction and that meets the
  diagnostic criteria for autism spectrum disorder specified by the
  Diagnostic and Statistical Manual of Mental Disorders, 5th edition,
  or a later edition; or
                     (B)  a diagnosis made using a previous edition of
  the Diagnostic and Statistical Manual of Mental Disorders of
  [includes] autism, Asperger's syndrome, or Pervasive Developmental
  Disorder--Not Otherwise Specified.
         SECTION 2.  Sections 1355.015(a-1) and (c-1), Insurance
  Code, are amended to read as follows:
         (a-1)  At a minimum, a health benefit plan must provide
  coverage for treatment of autism spectrum disorder as provided by
  this section to an enrollee who is diagnosed with autism spectrum
  disorder from the date of diagnosis[, only if the diagnosis was in
  place prior to the child's 10th birthday].
         (c-1)  The health benefit plan may [is] not require [required
  to provide coverage under Subsection (b) for benefits for] an
  enrollee to be evaluated for autism spectrum disorder more than
  once every 10 years [of age or older for applied behavior analysis
  in an amount that exceeds $36,000 per year].
         SECTION 3.  The changes in law made by this Act apply only to
  a health benefit plan delivered, issued for delivery, or renewed on
  or after January 1, 2024. A health benefit plan delivered, issued
  for delivery, or renewed before January 1, 2024, is governed by the
  law as it existed immediately before the effective date of this Act,
  and that law is continued in effect for that purpose.
         SECTION 4.  This Act takes effect September 1, 2023.