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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for treatment of autism. |
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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 Subsections (a-1) and (c-1) and adding Subsection (c-2) to |
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read as follows: |
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(a-1) At a minimum, a health benefit plan must provide |
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coverage for treatment of autism spectrum disorder as provided by |
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this section to an enrollee who is diagnosed with autism spectrum |
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disorder from the date of diagnosis, only if the diagnosis was in |
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place prior to the enrollee's 22nd [child's 10th] birthday. |
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(c-1) The health benefit plan may [is] not require [required |
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to provide coverage under Subsection (b) for benefits for] an |
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enrollee to be evaluated for autism spectrum disorder more than |
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once every 10 years [of age or older for applied behavior analysis |
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in an amount that exceeds $36,000 per year]. |
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(c-2) The health benefit plan may not prohibit or place a |
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limitation on a health care practitioner described by Subsection |
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(b)(1) from performing an evaluation requested by the plan's |
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issuer. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2022. A health benefit plan delivered, |
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issued for delivery, or renewed before January 1, 2022, is governed |
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by the law as it existed immediately before the effective date of |
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this Act, and that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2021. |