| 1 | 1 | | By: Watson, et al. S.B. No. 1484 |
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| 2 | 2 | | (Gonzales, Simmons, Thompson of Harris) |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to health benefit plan coverage for enrollees diagnosed |
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| 8 | 8 | | with autism spectrum disorder. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 1355.015, Insurance Code, is amended by |
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| 11 | 11 | | amending Subsection (a) and adding Subsections (c-1) and (f) to |
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| 12 | 12 | | read as follows: |
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| 13 | 13 | | (a) At a minimum, a health benefit plan must provide |
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| 14 | 14 | | coverage as provided by this section to an enrollee who is diagnosed |
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| 15 | 15 | | with autism spectrum disorder from the date of diagnosis, only if |
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| 16 | 16 | | the diagnosis was in place prior to the child's 10th birthday [until |
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| 17 | 17 | | the enrollee completes nine years of age. If an enrollee who is |
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| 18 | 18 | | being treated for autism spectrum disorder becomes 10 years of age |
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| 19 | 19 | | or older and continues to need treatment, this subsection does not |
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| 20 | 20 | | preclude coverage of treatment and services described by Subsection |
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| 21 | 21 | | (b)]. |
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| 22 | 22 | | (c-1) The health benefit plan is not required to provide |
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| 23 | 23 | | coverage under Subsection (b) for benefits for an enrollee 10 years |
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| 24 | 24 | | of age or older for applied behavior analysis in an amount that |
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| 25 | 25 | | exceeds $36,000 per year. |
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| 26 | 26 | | (f) To the extent that this section would otherwise require |
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| 27 | 27 | | this state to make a payment under 42 U.S.C. Section |
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| 28 | 28 | | 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 |
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| 29 | 29 | | C.F.R. Section 155.20, is not required to provide a benefit under |
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| 30 | 30 | | this section that exceeds the specified essential health benefits |
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| 31 | 31 | | required under 42 U.S.C. Section 18022(b). |
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| 32 | 32 | | SECTION 2. The heading to Section 1355.015, Insurance Code, |
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| 33 | 33 | | is amended to read as follows: |
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| 34 | 34 | | Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN ENROLLEES |
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| 35 | 35 | | [CHILDREN]. |
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| 36 | 36 | | SECTION 3. Section 1355.015, Insurance Code, as amended by |
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| 37 | 37 | | this Act, applies only to a health benefit plan that is delivered, |
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| 38 | 38 | | issued for delivery, or renewed on or after the effective date of |
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| 39 | 39 | | this Act. A health benefit plan that is delivered, issued for |
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| 40 | 40 | | delivery, or renewed before the effective date of this Act is |
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| 41 | 41 | | covered by the law in effect at the time the health benefit plan is |
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| 42 | 42 | | delivered, issued for delivery, or renewed, and that law is |
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| 43 | 43 | | continued in effect for that purpose. |
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| 44 | 44 | | SECTION 4. This Act takes effect September 1, 2013. |
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