89R2591 RDR-D
By: Menéndez S.B. No. 562
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 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 of [includes] autism, Asperger's
syndrome, or Pervasive Developmental Disorder--Not Otherwise
Specified made using a previous edition of the Diagnostic and
Statistical Manual of Mental Disorders.
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 limit [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].
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, 2026. A health benefit plan delivered, issued
for delivery, or renewed before January 1, 2026, 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, 2025.