HB 1919, Senate committee printing, as follows:
(1) Insert a new SECTION of the bill, appropriately
numbered, to read as follows:
SECTION ___. The heading to Subchapter A, Chapter 1355,
Insurance Code, is amended to read as follows:
SUBCHAPTER A. GROUP HEALTH BENEFIT PLAN COVERAGE
FOR CERTAIN SERIOUS MENTAL ILLNESSES AND OTHER DISORDERS
(2) Insert a new SECTION of the bill, appropriately
numbered, to read as follows:
SECTION ___. Section 1355.001, Insurance Code, is amended by
amending Subdivision (1) and by adding Subdivisions (3) and (4) to
read as follows:
(1) "Serious mental illness" means the following
psychiatric illnesses as defined by the American Psychiatric
Association in the Diagnostic and Statistical Manual (DSM):
(A) bipolar disorders (hypomanic, manic,
depressive, and mixed);
(B) depression in childhood and adolescence;
(C) major depressive disorders (single episode
or recurrent);
(D) obsessive-compulsive disorders;
(E) paranoid and other psychotic disorders;
(F) [pervasive developmental disorders;
[(G)] schizo-affective disorders (bipolar or
depressive); and
(G) [(H)] schizophrenia.
(3) "Autism spectrum disorder" means a
neurobiological disorder that includes autism, Asperger's
syndrome, or Pervasive Developmental Disorder--Not Otherwise
Specified.
(4) "Neurobiological disorder" means an illness of the
nervous system caused by genetic, metabolic, or other biological
factors.
(3) Insert a new SECTION of the bill, appropriately
numbered, to read as follows:
SECTION ___. Subchapter A, Chapter 1355, Insurance Code, is
amended by adding Section 1355.015 to read as follows:
Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN CHILDREN. (a)
At a minimum, a health benefit plan must provide coverage as
provided by this section to an enrollee older than two years of age
and younger than six years of age who is diagnosed with autism
spectrum disorder. If an enrollee who is being treated for autism
spectrum disorder becomes six years of age or older and continues to
need treatment, this subsection does not preclude coverage of
treatment and services described by Subsection (b).
(b) The health benefit plan must provide coverage under this
section to the enrollee for all generally recognized services
prescribed in relation to autism spectrum disorder by the
enrollee's primary care physician in the treatment plan recommended
by that physician. An individual providing treatment prescribed
under this subsection must be a health care practitioner:
(1) who is licensed, certified, or registered by an
appropriate agency of this state;
(2) whose professional credential is recognized and
accepted by an appropriate agency of the United States; or
(3) who is certified as a provider under the TRICARE
military health system.
(c) For purposes of Subsection (b), "generally recognized
services" may include services such as:
(1) evaluation and assessment services;
(2) applied behavior analysis;
(3) behavior training and behavior management;
(4) speech therapy;
(5) occupational therapy;
(6) physical therapy; or
(7) medications or nutritional supplements used to
address symptoms of autism spectrum disorder.
(d) Coverage under Subsection (b) may be subject to annual
deductibles, copayments, and coinsurance that are consistent with
annual deductibles, copayments, and coinsurance required for other
coverage under the health benefit plan.
(e) Notwithstanding any other law, this section does not
apply to a standard health benefit plan provided under Chapter
1507.
(4) Renumber the SECTIONS of the bill accordingly.