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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 1355.001(3), Insurance Code, is amended |
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to read as follows: |
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(3) "Autism spectrum disorder" means: |
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(A) a neurobiological disorder or developmental |
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disability that significantly affects verbal communication, |
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nonverbal communication, and social interaction and that meets the |
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diagnostic criteria for autism spectrum disorder specified by the |
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Diagnostic and Statistical Manual of Mental Disorders, 5th edition, |
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or a later edition; or |
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(B) a diagnosis made using a previous edition of |
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the Diagnostic and Statistical Manual of Mental Disorders of |
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[includes] autism, Asperger's syndrome, or Pervasive Developmental |
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Disorder--Not Otherwise Specified. |
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SECTION 2. Sections 1355.015(a-1) and (c-1), Insurance |
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Code, are amended to 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 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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SECTION 3. The changes in law made by this Act apply only to |
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a health benefit plan delivered, issued for delivery, or renewed on |
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or after January 1, 2024. A health benefit plan delivered, issued |
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for delivery, or renewed before January 1, 2024, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2023. |