Relating to health benefit plan coverage for treatment of autism spectrum disorders.
Impact
The enactment of HB 564 is expected to have a substantial impact on how health benefit plans manage coverage for autism-related treatments. By standardizing coverage for medically necessary services, including applied behavior analysis, speech therapy, and other therapeutic interventions, the bill ensures that individuals with ASD have access to the care they require. The changes are anticipated to alleviate financial burdens on families seeking treatment and to promote early intervention, which is crucial for effective management of autism spectrum disorders.
Summary
House Bill 564 seeks to amend the Texas Insurance Code to ensure that health benefit plans provide necessary coverage for the treatment of autism spectrum disorders (ASD). The bill redefines 'autism spectrum disorder' and mandates that insurers cover medically necessary treatments for individuals diagnosed with ASD, regardless of age, from the date of diagnosis. This is a significant shift from the previous requirement which limited coverage to diagnoses made prior to a child's 10th birthday.
Contention
While proponents of the bill emphasize the importance of access to necessary treatments for those diagnosed with autism, there are potential points of contention regarding the definition of 'medically necessary' and the extent of coverage. Critics may argue that expanding coverage could lead to increased costs for insurers and, consequently, higher insurance premiums. Additionally, discussions surrounding the standards of care and the types of therapies covered may arise, as stakeholders seek to ensure that the treatments provided are evidence-based and effective.
Texas Constitutional Statutes Affected
Insurance Code
Chapter 1355. Benefits For Certain Mental Disorders