00                            HOUSE BILL NO. 187                                                                          
01 "An Act requiring insurance coverage for autism spectrum disorders, describing the                                      
02 method for establishing a treatment plan for those disorders, and defining the treatment                                
03 required for those disorders; and providing for an effective date."                                                     
04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
05    * Section 1. AS 21.42 is amended by adding a new section to read:                                                  
06            Sec. 21.42.397. Coverage for autism spectrum disorders. (a) Except for a                                   
07       fraternal benefit society, a health care insurer that offers, issues for delivery, delivers,                      
08       or renews a health care insurance plan in this state shall provide coverage for the costs                         
09       of the diagnosis and treatment of autism spectrum disorders. Coverage for the cost of                             
10       treatment required by this subsection must cover the treatment of the disorders                                   
11       prescribed by a licensed physician or psychologist and provided by an autism service                              
12       provider as identified in a treatment plan developed following a comprehensive                                    
13       evaluation. A treatment plan developed under this subsection must identify the                                    
14       medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative                           

01       care, and therapeutic care required. In this subsection,                                                          
02                 (1)  "medically necessary" means any care, treatment, intervention,                                     
03       service, or item prescribed by a licensed physician or psychologist in accordance with                            
04       accepted standards of practice that will, or is reasonably expected to,                                           
05                      (A)  prevent the onset of an illness, condition, injury, or                                        
06            disability;                                                                                                  
07                      (B)  reduce or ameliorate the physical, mental, or developmental                                   
08            effects of an illness, condition, injury, or disability;                                                     
09                      (C)  assist in achieving or maintaining maximum functional                                         
10            capacity in performing daily activities;                                                                     
11                 (2)  "rehabilitative care" means professional counseling, guidance                                      
12       services, and treatment programs, including applied behavior analysis necessary to                                
13       develop, restore, and maintain the functioning of an individual to the maximum extent                             
14       practicable; in this paragraph, "applied behavior analysis" means the design,                                     
15       implementation, and evaluation of environmental modifications, using behavioral                                   
16       stimuli and consequences, including direct observation, measurement, and functional                               
17       analysis of the relationship between environment and behavior, to produce socially                                
18       significant improvement in human behavior or to prevent the loss of an attained skill                             
19       or function;                                                                                                      
20                 (3)  "therapeutic care" means services provided by or under the                                         
21       supervision of a speech-language pathologist licensed under AS 08.11 or an                                        
22       occupational therapist or physical therapist licensed under AS 08.84.                                             
23            (b)  Coverage under this section                                                                             
24                 (1)  is required to be provided only to individuals under 21 years of                                   
25       age;                                                                                                              
26                 (2)  must provide a maximum benefit of $36,000 a year, adjusted                                         
27       annually, beginning January 1, 2011, by the percentage change in the Consumer Price                               
28       Index for all urban consumers compiled by the United States Department of Labor,                                  
29       Bureau of Labor Statistics; payments made by an insurer on behalf of a covered                                    
30       individual for treatment of a medical condition unrelated to the individual's autism                              
31       spectrum disorder may not be applied toward the maximum benefit established in this                               

01       paragraph;                                                                                                        
02                 (3)  may not limit the number of visits to an autism service provider for                               
03       treatment;                                                                                                        
04                 (4)  is subject to copayment, deductible, and coinsurance provisions,                                   
05       and other general exclusions or limitations included in a health insurance policy to the                          
06       same extent as other health care services covered by the policy; and                                              
07                 (5)  must cover treatment that is coordinated with an education                                         
08       program, but may not be contingent on the coordination of treatment with an                                       
09       education program.                                                                                                
10            (c)  This section does not limit benefits that are otherwise available to an                                 
11       individual under a health care insurance plan.                                                                    
12            (d)  A health care insurer may not terminate, refuse to deliver, execute, issue,                             
13       amend, or renew coverage to an individual because the individual is diagnosed with or                             
14       received treatment of autism spectrum disorders.                                                                  
15            (e)  In this section,                                                                                        
16                 (1)  "autism service provider" means a person, entity, or group                                         
17       providing treatment of autism spectrum disorders;                                                                 
18                 (2)  "autism spectrum disorders" are those defined by the current                                       
19       edition of the American Psychiatric Association's Diagnostic and Statistical Manual of                            
20       Mental Disorders, including autistic disorder, Asperger's disorder, and pervasive                                 
21       developmental disorder not otherwise specified;                                                                   
22                 (3)  "health care insurance plan" has the meaning given in                                              
23       AS 21.54.500;                                                                                                     
24                 (4)  "health care insurer" has the meaning given in AS 21.54.500.                                       
25    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
26 read:                                                                                                                   
27       APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health                                   
28 insurance policy that is offered, issued for delivery, delivered, or renewed on or after                                
29 January 1, 2010.                                                                                                        
30    * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).