By: Watson, et al. S.B. No. 1484
(Gonzales, Simmons, Thompson of Harris)
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for enrollees diagnosed
with 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 Subsection (a) and adding Subsections (c-1) and (f) to
read as follows:
(a) At a minimum, a health benefit plan must provide
coverage as provided by this section to an enrollee who is diagnosed
with autism spectrum disorder from the date of diagnosis, only if
the diagnosis was in place prior to the child's 10th birthday [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)].
(c-1) The health benefit plan is not required to provide
coverage under Subsection (b) for benefits for an enrollee 10 years
of age or older for applied behavior analysis in an amount that
exceeds $36,000 per year.
(f) To the extent that this section would otherwise require
this state to make a payment under 42 U.S.C. Section
18031(d)(3)(B)(ii), a qualified health plan, as defined by 45
C.F.R. Section 155.20, is not required to provide a benefit under
this section that exceeds the specified essential health benefits
required under 42 U.S.C. Section 18022(b).
SECTION 2. The heading to Section 1355.015, Insurance Code,
is amended to read as follows:
Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN ENROLLEES
[CHILDREN].
SECTION 3. Section 1355.015, Insurance Code, as amended by
this Act, applies only to a health benefit plan that is delivered,
issued for delivery, or renewed on or after the effective date of
this Act. A health benefit plan that is delivered, issued for
delivery, or renewed before the effective date of this Act is
covered by the law in effect at the time the health benefit plan is
delivered, issued for delivery, or renewed, and that law is
continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2013.