By: Simmons H.B. No. 3276
A BILL TO BE ENTITLED
AN ACT
relating to the coverage by certain health benefit plans for the
screening and treatment of autism spectrum disorder.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.015, Insurance Code, is amended to
read as follows:
Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN CHILDREN.
(a) A health benefit plan must provide coverage for screening for
autism spectrum disorder.
(b) At a minimum, a health benefit plan providing coverage
under Subsection (a) must provide coverage for screening at 18 and
24 months.
(c) At a minimum, a health benefit plan must provide
coverage for treatment of autism spectrum disorder as provided by
this section to an enrollee who is diagnosed with autism spectrum
disorder from the date of diagnosis until the enrollee completes
nine years of age. If an enrollee who is being treated for autism
spectrum disorder becomes 10 years of age or older and continues to
need treatment, this subsection does not preclude coverage of
treatment and services described by Subsection (b)(d).
(b)(d) 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:
(1) a health care practitioner:
(1)(A) who is licensed, certified, or registered by an
appropriate agency of this state;
(2)(B) whose professional credential is recognized
and accepted by an appropriate agency of the United States; or
(3)(C) who is certified as a provider under the
TRICARE military health system; or
(2) an individual acting under the supervision of a health
care practitioner under Subsection (d)(1).
(c)(e) For purpose of Subsection (b)(d), "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)(f) Coverage under Subsection (b)(d) 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)(g) Notwithstanding any other law, this section does not
apply to a standard health benefit plan provided under Chapter
1507.
(h) Subsection (a) does not apply to a qualified health plan
as defined by 45 C.F.R. Section 155.20 if a determination has been
made pursuant to 45 C.F.R. Section 155.170 that:
(1) this subchapter requires the qualified health plan
to offer benefits in addition to the essential health benefits
required under 42 U.S.C. 18022(b); and
(2) the State of Texas must make payments to defray the
cost of the additional benefits mandated by this subchapter.
SECTION 2. Chapter 1355, Insurance Code, as amended by this
act, applies only to a health benefit plan delivered, issued for
delivery, or renewed on or after January 1, 2014. A health benefit
plan delivered, issued for delivery, or renewed before January 1,
2014 is governed by the law in effect immediately before the
effective date of this act, and that law is continued in effect for
that purpose.
SECTION 3. This act takes effect September 1, 2013.