88R7283 JES-D
By: Cortez H.B. No. 4506
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for treatment of autism.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1355.001(3), Insurance Code, is amended
to read as follows:
(3) "Autism spectrum disorder" means:
(A) a neurobiological disorder or developmental
disability that significantly affects verbal communication,
nonverbal communication, and social interaction and that meets the
diagnostic criteria for autism spectrum disorder specified by the
Diagnostic and Statistical Manual of Mental Disorders, 5th edition,
or a later edition; or
(B) a diagnosis made using a previous edition of
the Diagnostic and Statistical Manual of Mental Disorders of
[includes] autism, Asperger's syndrome, or Pervasive Developmental
Disorder--Not Otherwise Specified.
SECTION 2. Sections 1355.015(a-1) and (c-1), Insurance
Code, are amended to read as follows:
(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[, only if the diagnosis was in
place prior to the child's 10th birthday].
(c-1) The health benefit plan may [is] not require [required
to provide coverage under Subsection (b) for benefits for] an
enrollee to be evaluated for autism spectrum disorder more than
once every 10 years [of age or older for applied behavior analysis
in an amount that exceeds $36,000 per year].
SECTION 3. The changes in law made by this Act apply only to
a health benefit plan delivered, issued for delivery, or renewed on
or after January 1, 2024. A health benefit plan delivered, issued
for delivery, or renewed before January 1, 2024, is governed by the
law as it existed immediately before the effective date of this Act,
and that law is continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2023.