Bill Summary – FastDemocracy

         
            88R23922 JES-D
         
		By: Cortez, Garcia, et al.
            H.B. No. 4506
         
               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 or developmental 
         
            disability 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 made using a previous edition of 
         
            the Diagnostic and Statistical Manual of Mental Disorders of
         
            [includes] autism, Asperger's syndrome, or Pervasive Developmental 
         
            Disorder--Not Otherwise Specified.
         
                   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, 2024.  A health benefit plan delivered, issued 
         
            for delivery, or renewed before January 1, 2024, 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, 2023.
         
Statutes affected: 
Introduced: Insurance Code 1355.001 (Insurance Code 1355)
House Committee Report: Insurance Code 1355.001 (Insurance Code 1355)
Engrossed: Insurance Code 1355.001 (Insurance Code 1355)



	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 or developmental
	disability 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 made using a previous edition of
	the Diagnostic and Statistical Manual of Mental Disorders of
	[~~includes~~] autism, Asperger's syndrome, or Pervasive Developmental
	Disorder--Not Otherwise Specified.
	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, 2024. A health benefit plan delivered, issued
	for delivery, or renewed before January 1, 2024, 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, 2023.