| 1 | 1 | | 89R2591 RDR-D |
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| 2 | 2 | | By: Menéndez S.B. No. 562 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to health benefit plan coverage for treatment of autism. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Section 1355.001(3), Insurance Code, is amended |
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| 12 | 12 | | to read as follows: |
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| 13 | 13 | | (3) "Autism spectrum disorder" means: |
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| 14 | 14 | | (A) a neurobiological disorder that |
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| 15 | 15 | | significantly affects verbal communication, nonverbal |
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| 16 | 16 | | communication, and social interaction and that meets the diagnostic |
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| 17 | 17 | | criteria for autism spectrum disorder specified by the Diagnostic |
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| 18 | 18 | | and Statistical Manual of Mental Disorders, 5th edition, or a later |
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| 19 | 19 | | edition; or |
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| 20 | 20 | | (B) a diagnosis of [includes] autism, Asperger's |
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| 21 | 21 | | syndrome, or Pervasive Developmental Disorder--Not Otherwise |
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| 22 | 22 | | Specified made using a previous edition of the Diagnostic and |
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| 23 | 23 | | Statistical Manual of Mental Disorders. |
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| 24 | 24 | | SECTION 2. Sections 1355.015(a-1) and (c-1), Insurance |
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| 25 | 25 | | Code, are amended to read as follows: |
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| 26 | 26 | | (a-1) At a minimum, a health benefit plan must provide |
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| 27 | 27 | | coverage for treatment of autism spectrum disorder as provided by |
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| 28 | 28 | | this section to an enrollee who is diagnosed with autism spectrum |
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| 29 | 29 | | disorder from the date of diagnosis[, only if the diagnosis was in |
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| 30 | 30 | | place prior to the child's 10th birthday]. |
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| 31 | 31 | | (c-1) The health benefit plan may [is] not limit [required |
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| 32 | 32 | | to provide] coverage under Subsection (b) for benefits for an |
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| 33 | 33 | | enrollee [10 years of age or older for applied behavior analysis in |
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| 34 | 34 | | an amount that exceeds $36,000 per year]. |
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| 35 | 35 | | SECTION 3. The changes in law made by this Act apply only to |
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| 36 | 36 | | a health benefit plan delivered, issued for delivery, or renewed on |
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| 37 | 37 | | or after January 1, 2026. A health benefit plan delivered, issued |
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| 38 | 38 | | for delivery, or renewed before January 1, 2026, is governed by the |
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| 39 | 39 | | law as it existed immediately before the effective date of this Act, |
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| 40 | 40 | | and that law is continued in effect for that purpose. |
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| 41 | 41 | | SECTION 4. This Act takes effect September 1, 2025. |
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