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AN ACT
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relating to health benefit plan coverage for enrollees diagnosed |
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with autism spectrum disorder. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1355.015, Insurance Code, is amended by |
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amending Subsection (a) and adding Subsections (c-1) and (f) to |
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read as follows: |
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(a) At a minimum, a health benefit plan must provide |
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coverage as provided by this section to an enrollee who is diagnosed |
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with autism spectrum disorder from the date of diagnosis, only if |
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the diagnosis was in place prior to the child's 10th birthday [until
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the enrollee completes nine years of age.
If an enrollee who is
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being treated for autism spectrum disorder becomes 10 years of age
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or older and continues to need treatment, this subsection does not
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preclude coverage of treatment and services described by Subsection
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(b)]. |
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(c-1) The health benefit plan is not required to provide |
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coverage under Subsection (b) for benefits for an enrollee 10 years |
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of age or older for applied behavior analysis in an amount that |
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exceeds $36,000 per year. |
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(f) To the extent that this section would otherwise require |
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this state to make a payment under 42 U.S.C. Section |
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18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 |
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C.F.R. Section 155.20, is not required to provide a benefit under |
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this section that exceeds the specified essential health benefits |
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required under 42 U.S.C. Section 18022(b). |
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SECTION 2. The heading to Section 1355.015, Insurance Code, |
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is amended to read as follows: |
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Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN ENROLLEES |
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[CHILDREN]. |
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SECTION 3. Section 1355.015, Insurance Code, as amended by |
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this Act, applies only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after the effective date of |
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this Act. A health benefit plan that is delivered, issued for |
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delivery, or renewed before the effective date of this Act is |
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covered by the law in effect at the time the health benefit plan is |
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delivered, issued for delivery, or renewed, and that law is |
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continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2013. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 1484 passed the Senate on |
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May 1, 2013, by the following vote: Yeas 18, Nays 13. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 1484 passed the House on |
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May 21, 2013, by the following vote: Yeas 147, Nays 0, two |
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present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |