bill widening autism insurance coverage

The text as introduced · 314 words

89R2591 RDR-D

By: Cortez
H.B. No. 813

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 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 of [ includes ] autism, Asperger's

syndrome, or Pervasive Developmental Disorder--Not Otherwise

Specified made using a previous edition of the Diagnostic and

Statistical Manual of Mental Disorders .

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, 2026. A health benefit plan delivered, issued

for delivery, or renewed before January 1, 2026, 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, 2025.