Texas SB563 mandates health benefit plans to cover medically necessary treatments for autism spectrum disorder from the date of diagnosis.

SB563 amends the Texas Insurance Code to require health benefit plans to cover medically necessary treatments for autism spectrum disorder from the date of diagnosis. The bill defines "medically necessary" treatments as those addressing specific patient needs, delivered according to recognized mental health and substance use disorder care standards. It prohibits plans from restricting the setting of these treatments unless the enrollee qualifies for Medicaid services. The changes apply to plans delivered, issued for delivery, or renewed on or after January 1, 2026.

Texas SB563 mandates health benefit plans to cover medically necessary treatments for autism spectrum disorder from the date of diagnosis.

SB563 amends the Texas Insurance Code to require health benefit plans to cover medically necessary treatments for autism spectrum disorder from the date of diagnosis. The bill defines "medically necessary" treatments as those addressing specific patient needs, delivered according to recognized mental health and substance use disorder care standards. It prohibits plans from restricting the setting of these treatments unless the enrollee qualifies for Medicaid services. The changes apply to plans delivered, issued for delivery, or renewed on or after January 1, 2026.