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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for enrollees diagnosed |
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with 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 by |
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amending Subsection (a) and adding Subsection (f) to read as |
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follows: |
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(a) At a minimum, a health benefit plan must provide |
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coverage as provided by this section to an enrollee who is diagnosed |
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with autism spectrum disorder from the date of diagnosis [until the
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enrollee completes nine years of age.
If an enrollee who is being
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treated for autism spectrum disorder becomes 10 years of age or
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older and continues to need treatment, this subsection does not
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preclude coverage of treatment and services described by Subsection
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(b)]. |
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(f) To the extent that this section would otherwise require |
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this state to make a payment under 42 U.S.C. Section |
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18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 |
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C.F.R. Section 155.20, is not required to provide a benefit under |
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this section that exceeds the specified essential health benefits |
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required under 42 U.S.C. Section 18022(b). |
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SECTION 2. The heading to Section 1355.015, Insurance Code, |
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is amended to read as follows: |
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Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN ENROLLEES |
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[CHILDREN]. |
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SECTION 3. (a) Subsection (a), Section 1355.015, |
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Insurance Code, as amended by this Act, applies only to a health |
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benefit plan that is delivered, issued for delivery, or renewed on |
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or after the effective date of this Act. A health benefit plan that |
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is delivered, issued for delivery, or renewed before the effective |
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date of this Act is covered by the law in effect at the time the |
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health benefit plan is delivered, issued for delivery, or renewed, |
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and that law is continued in effect for that purpose. |
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(b) Subsection (f), Section 1355.015, Insurance Code, as |
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added by this Act, applies only to a health benefit plan that is |
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delivered, issued for delivery, or renewed on or after January 1, |
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2014. A health benefit plan that is delivered, issued for delivery, |
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or renewed before January 1, 2014, is covered by the law in effect |
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at the time the health benefit plan is delivered, issued for |
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delivery, or renewed, and that law is continued in effect for that |
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purpose. |
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SECTION 4. This Act takes effect September 1, 2013. |
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