Texas 2013 - 83rd Regular

Texas House Bill HB3276 Compare Versions

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1	1	By: Simmons, et al. (Senate Sponsor - Deuell) H.B. No. 3276
2	2	(In the Senate - Received from the House May 10, 2013;
3	3	May 10, 2013, read first time and referred to Committee on State
4	4	Affairs; May 20, 2013, reported favorably by the following vote:
5	5	Yeas 5, Nays 1; May 20, 2013, sent to printer.)
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to the coverage by certain health benefit plans for the
11	11	screening and treatment of autism spectrum disorder.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Section 1355.015, Insurance Code, is amended by
14	14	amending Subsections (a) and (b) and adding Subsections (a-1) and
15	15	(f) to read as follows:
16	16	(a) At a minimum, a health benefit plan must provide
17	17	coverage for screening a child for autism spectrum disorder at the
18	18	ages of 18 and 24 months.
19	19	(a-1) At a minimum, a health benefit plan must provide
20	20	coverage for treatment of autism spectrum disorder as provided by
21	21	this section to an enrollee who is diagnosed with autism spectrum
22	22	disorder from the date of diagnosis until the enrollee completes
23	23	nine years of age. If an enrollee who is being treated for autism
24	24	spectrum disorder becomes 10 years of age or older and continues to
25	25	need treatment, this subsection does not preclude coverage of
26	26	treatment and services described by Subsection (b).
27	27	(b) The health benefit plan must provide coverage under this
28	28	section to the enrollee for all generally recognized services
29	29	prescribed in relation to autism spectrum disorder by the
30	30	enrollee's primary care physician in the treatment plan recommended
31	31	by that physician. An individual providing treatment prescribed
32	32	under this subsection must be:
33	33	(1) a health care practitioner:
34	34	(A) [(1)] who is licensed, certified, or
35	35	registered by an appropriate agency of this state;
36	36	(B) [(2)] whose professional credential is
37	37	recognized and accepted by an appropriate agency of the United
38	38	States; or
39	39	(C) [(3)] who is certified as a provider under
40	40	the TRICARE military health system; or
41	41	(2) an individual acting under the supervision of a
42	42	health care practitioner described by Subdivision (1).
43	43	(f) Subsection (a) does not apply to a qualified health plan
44	44	defined by 45 C.F.R. Section 155.20 if a determination is made under
45	45	45 C.F.R. Section 155.170 that:
46	46	(1) this subchapter requires the qualified health plan
47	47	to offer benefits in addition to the essential health benefits
48	48	required under 42 U.S.C. Section 18022(b); and
49	49	(2) this state must make payments to defray the cost of
50	50	the additional benefits mandated by this subchapter.
51	51	SECTION 2. Section 1355.015, Insurance Code, as amended by
52	52	this Act, applies only to a health benefit plan delivered, issued
53	53	for delivery, or renewed on or after January 1, 2014. A health
54	54	benefit plan delivered, issued for delivery, or renewed before
55	55	January 1, 2014, is governed by the law in effect immediately before
56	56	the effective date of this Act, and that law is continued in effect
57	57	for that purpose.
58	58	SECTION 3. This Act takes effect September 1, 2013.
59	59	* * * * *