Bill > HB564

This bill updates Texas insurance code provisions regarding health benefit plan coverage for autism spectrum disorders (ASD). The bill expands the definition of ASD to include a more comprehensive description based on the Diagnostic and Statistical Manual of Mental Disorders, ensuring coverage for various manifestations of the disorder. It eliminates the previous age restriction for coverage, mandating that health benefit plans provide coverage for medically necessary ASD treatment from the date of diagnosis. The bill introduces a detailed definition of "medically necessary" services, which includes treatments that address patient-specific needs, prevent illness progression, and maintain skills. The legislation also specifies that generally recognized services for ASD can include evaluations, applied behavior analysis, speech therapy, occupational therapy, physical therapy, and medications. Importantly, the bill prohibits health benefit plans from restricting healthcare practitioners' ability to evaluate ASD or limiting the settings where ASD services can be provided. These changes will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, with the act taking effect on September 1, 2025.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB564