Bill > SB563

This bill updates Texas insurance law to expand health benefit plan coverage for individuals with autism spectrum disorders by modifying the definition of autism spectrum disorder and establishing detailed requirements for medically necessary treatment. The bill clarifies that "autism spectrum disorder" now includes diagnoses meeting the criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, and removes the previous age restriction limiting coverage to diagnoses before a child's 10th birthday. It introduces a comprehensive definition of "medically necessary" treatment, which must address patient-specific needs, prevent or manage symptoms, and be based on recognized independent standards of mental health care. The bill requires health benefit plans to cover a wide range of services including evaluations, applied behavior analysis, speech and occupational therapy, and prohibits plans from restricting the settings where these services can be provided. The 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. This legislation aims to ensure more comprehensive and flexible healthcare coverage for individuals with autism spectrum disorders.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB563