83R20736 SCL-D
By: Simmons, Bonnen of Galveston, Eiland, H.B. No. 3276
et al.
Substitute the following for H.B. No. 3276:
By: Morrison C.S.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 by
amending Subsections (a) and (b) and adding Subsections (a-1) and
(f) to read as follows:
(a) At a minimum, a health benefit plan must provide
coverage for screening a child for autism spectrum disorder at the
ages of 18 and 24 months.
(a-1) 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).
(b) 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:
(A) [(1)] who is licensed, certified, or
registered by an appropriate agency of this state;
(B) [(2)] whose professional credential is
recognized and accepted by an appropriate agency of the United
States; or
(C) [(3)] 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 described by Subdivision (1).
(f) Subsection (a) does not apply to a qualified health plan
defined by 45 C.F.R. Section 155.20 if a determination is made under
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. Section 18022(b); and
(2) this state must make payments to defray the cost of
the additional benefits mandated by this subchapter.
SECTION 2. Section 1355.015, 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.