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Lone Star State Adds Autism Coverage Mandate

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Texas has a new law that requires group insurers to provide autism spectrum disorder benefits for covered children ages 3 to 5 who have ASD.

The new law, which took effect Sept. 1, applies to any group health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident or sickness, officials at the Texas Department of Insurance write in Commissioner’s Bulletin Number B-0053-07.

The plans now must provide “coverage 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,” officials write.

Recognized services could include evaluation services, behavior training, speech therapy, occupational therapy, physical therapy, or medications, or nutritional supplements, officials write.

A carrier can apply the annual deductibles, co-payment requirements and coinsurance requirements it applies to other types of benefits to the ASD benefits.

Carriers must incorporate the new ASD benefits in any state-regulated health plan delivered, issued for delivery or renewed on or after Jan. 1, 2008.

A copy of the mandate bulletin is available