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A BILL TO BE ENTITLED
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AN ACT
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relating to the coverage by certain health benefit plans for the |
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screening and treatment of autism spectrum disorder. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1355.015, Insurance Code, is amended to |
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read as follows: |
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Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN CHILDREN. |
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(a) A health benefit plan must provide coverage for screening for |
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autism spectrum disorder. |
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(b) At a minimum, a health benefit plan providing coverage |
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under Subsection (a) must provide coverage for screening at 18 and |
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24 months. |
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(c) At a minimum, a health benefit plan must provide |
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coverage for treatment of autism spectrum disorder as provided by |
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this section to an enrollee who is diagnosed with autism spectrum |
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disorder from the date of diagnosis until the enrollee completes |
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nine years of age. If an enrollee who is being treated for autism |
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spectrum disorder becomes 10 years of age or older and continues to |
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need treatment, this subsection does not preclude coverage of |
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treatment and services described by Subsection (b)(d). |
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(b)(d) The health benefit plan must provide coverage under |
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this section to the enrollee for all generally recognized services |
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prescribed in relation to autism spectrum disorder by the |
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enrollee's primary care physician in the treatment plan recommended |
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by that physician. An individual providing treatment prescribed |
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under this subsection must be: |
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(1) a health care practitioner: |
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(1)(A) who is licensed, certified, or registered by an |
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appropriate agency of this state; |
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(2)(B) whose professional credential is recognized |
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and accepted by an appropriate agency of the United States; or |
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(3)(C) who is certified as a provider under the |
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TRICARE military health system; or |
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(2) an individual acting under the supervision of a health |
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care practitioner under Subsection (d)(1). |
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(c)(e) For purpose of Subsection (b)(d), "generally |
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recognized services" may include services such as: |
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(1) evaluation and assessment services; |
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(2) applied behavior analysis; |
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(3) behavior training and behavior management; |
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(4) speech therapy; |
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(5) occupational therapy; |
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(6) physical therapy; or |
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(7) medications or nutritional supplements used to |
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address symptoms of autism spectrum disorder. |
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(d)(f) Coverage under Subsection (b)(d) may be subject to |
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annual deductibles, copayments, and coinsurance that are |
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consistent with annual deductibles, copayments, and coinsurance |
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required for other coverage under the health benefit plan. |
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(e)(g) Notwithstanding any other law, this section does not |
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apply to a standard health benefit plan provided under Chapter |
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1507. |
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(h) Subsection (a) does not apply to a qualified health plan |
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as defined by 45 C.F.R. Section 155.20 if a determination has been |
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made pursuant to 45 C.F.R. Section 155.170 that: |
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(1) this subchapter requires the qualified health plan |
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to offer benefits in addition to the essential health benefits |
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required under 42 U.S.C. 18022(b); and |
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(2) the State of Texas must make payments to defray the |
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cost of the additional benefits mandated by this subchapter. |
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SECTION 2. Chapter 1355, Insurance Code, as amended by this |
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act, applies only to a health benefit plan delivered, issued for |
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delivery, or renewed on or after January 1, 2014. A health benefit |
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plan delivered, issued for delivery, or renewed before January 1, |
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2014 is governed by the law in effect immediately before the |
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effective date of this act, and that law is continued in effect for |
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that purpose. |
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SECTION 3. This act takes effect September 1, 2013. |