89R2591 RDR-D

By: Cortez H.B. No. 813

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 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 of [includes] autism, Asperger's syndrome, or Pervasive Developmental Disorder--Not Otherwise Specified made using a previous edition of the Diagnostic and Statistical Manual of Mental Disorders.

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 limit [required to provide] coverage under Subsection (b) for benefits for an enrollee [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, 2026. A health benefit plan delivered, issued for delivery, or renewed before January 1, 2026, 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, 2025.