Bill Text: TX HB3276 | 2013-2014 | 83rd Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the coverage by certain health benefit plans for the screening and treatment of autism spectrum disorder.
Spectrum: Bipartisan Bill
Status: (Passed) 2013-06-14 - Effective on 9/1/13 [HB3276 Detail]
Download: Texas-2013-HB3276-Introduced.html
Bill Title: Relating to the coverage by certain health benefit plans for the screening and treatment of autism spectrum disorder.
Spectrum: Bipartisan Bill
Status: (Passed) 2013-06-14 - Effective on 9/1/13 [HB3276 Detail]
Download: Texas-2013-HB3276-Introduced.html
By: Simmons | H.B. No. 3276 |
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relating to the coverage by certain health benefit plans for the | ||
screening and treatment of autism spectrum disorder. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1355.015, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1355.015. REQUIRED COVERAGE FOR CERTAIN CHILDREN. | ||
(a) A health benefit plan must provide coverage for screening for | ||
autism spectrum disorder. | ||
(b) At a minimum, a health benefit plan providing coverage | ||
under Subsection (a) must provide coverage for screening at 18 and | ||
24 months. | ||
(c) 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 until the enrollee completes | ||
nine years of age. If an enrollee who is being treated for autism | ||
spectrum disorder becomes 10 years of age or older and continues to | ||
need treatment, this subsection does not preclude coverage of | ||
treatment and services described by Subsection |
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this section to the enrollee for all generally recognized services | ||
prescribed in relation to autism spectrum disorder by the | ||
enrollee's primary care physician in the treatment plan recommended | ||
by that physician. An individual providing treatment prescribed | ||
under this subsection must be: | ||
(1) a health care practitioner: | ||
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appropriate agency of this state; | ||
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and accepted by an appropriate agency of the United States; or | ||
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TRICARE military health system; or | ||
(2) an individual acting under the supervision of a health | ||
care practitioner under Subsection (d)(1). | ||
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recognized services" may include services such as: | ||
(1) evaluation and assessment services; | ||
(2) applied behavior analysis; | ||
(3) behavior training and behavior management; | ||
(4) speech therapy; | ||
(5) occupational therapy; | ||
(6) physical therapy; or | ||
(7) medications or nutritional supplements used to | ||
address symptoms of autism spectrum disorder. | ||
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annual deductibles, copayments, and coinsurance that are | ||
consistent with annual deductibles, copayments, and coinsurance | ||
required for other coverage under the health benefit plan. | ||
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apply to a standard health benefit plan provided under Chapter | ||
1507. | ||
(h) Subsection (a) does not apply to a qualified health plan | ||
as defined by 45 C.F.R. Section 155.20 if a determination has been | ||
made pursuant to 45 C.F.R. Section 155.170 that: | ||
(1) this subchapter requires the qualified health plan | ||
to offer benefits in addition to the essential health benefits | ||
required under 42 U.S.C. 18022(b); and | ||
(2) the State of Texas must make payments to defray the | ||
cost of the additional benefits mandated by this subchapter. | ||
SECTION 2. Chapter 1355, Insurance Code, as amended by this | ||
act, applies only to a health benefit plan delivered, issued for | ||
delivery, or renewed on or after January 1, 2014. A health benefit | ||
plan delivered, issued for delivery, or renewed before January 1, | ||
2014 is governed by the law in effect immediately before the | ||
effective date of this act, and that law is continued in effect for | ||
that purpose. | ||
SECTION 3. This act takes effect September 1, 2013. |