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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 by |
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amending Subsections (a) and (b) and adding Subsections (a-1) and |
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(f) to read as follows: |
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(a) At a minimum, a health benefit plan must provide |
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coverage for screening a child for autism spectrum disorder at the |
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ages of 18 and 24 months. |
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(a-1) 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). |
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(b) The health benefit plan must provide coverage under this |
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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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(A) [(1)] who is licensed, certified, or |
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registered by an appropriate agency of this state; |
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(B) [(2)] whose professional credential is |
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recognized and accepted by an appropriate agency of the United |
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States; or |
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(C) [(3)] who is certified as a provider under |
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the TRICARE military health system; or |
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(2) an individual acting under the supervision of a |
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health care practitioner described by Subdivision (1). |
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(f) Subsection (a) does not apply to a qualified health plan |
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defined by 45 C.F.R. Section 155.20 if a determination is made under |
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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. Section 18022(b); and |
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(2) this state must make payments to defray the cost of |
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the additional benefits mandated by this subchapter. |
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SECTION 2. Section 1355.015, Insurance Code, as amended by |
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this Act, applies only to a health benefit plan delivered, issued |
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for delivery, or renewed on or after January 1, 2014. A health |
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benefit plan delivered, issued for delivery, or renewed before |
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January 1, 2014, is governed by the law in effect immediately before |
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the effective date of this Act, and that law is continued in effect |
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for that purpose. |
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SECTION 3. This Act takes effect September 1, 2013. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 3276 was passed by the House on May 9, |
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2013, by the following vote: Yeas 137, Nays 2, 3 present, not |
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voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 3276 was passed by the Senate on May |
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21, 2013, by the following vote: Yeas 22, Nays 9. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: _____________________ |
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Date |
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_____________________ |
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Governor |