SB 74: "An Act requiring insurance coverage for autism spectrum disorders, describing the method for establishing a covered treatment plan for those disorders, and defining the covered treatment for those disorders; and providing for an effective date."
00 SENATE BILL NO. 74 01 "An Act requiring insurance coverage for autism spectrum disorders, describing the 02 method for establishing a covered treatment plan for those disorders, and defining the 03 covered treatment 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 required by this 10 subsection must include treatment prescribed by a licensed physician or psychologist, 11 provided by or supervised by an autism service provider, and as identified in a 12 treatment plan developed following a comprehensive evaluation. Covered treatment 13 may include medically necessary pharmacy care, psychiatric care, psychological care,
01 habilitative or rehabilitative care, and therapeutic care. In this subsection, 02 (1) "habilitative or rehabilitative care" means professional counseling, 03 guidance services, and treatment programs, including applied behavior analysis or 04 other structured behavioral therapies necessary to develop, restore, and maintain the 05 functioning of an individual to the maximum extent practicable; in this paragraph, 06 "applied behavior analysis" means the design, implementation, and evaluation of 07 environmental modifications, using behavioral stimuli and consequences, including 08 direct observation, measurement, and functional analysis of the relationship between 09 environment and behavior, to produce socially significant improvement in human 10 behavior or to prevent the loss of an attained skill or function; 11 (2) "therapeutic care" means services provided by or under the 12 supervision of a speech-language pathologist licensed under AS 08.11 or an 13 occupational therapist or physical therapist licensed under AS 08.84. 14 (b) Coverage under this section 15 (1) is required to be provided only to individuals under 21 years of 16 age; 17 (2) may not limit the number of visits to an autism service provider for 18 treatment; 19 (3) is subject to copayment, deductible, and coinsurance provisions, 20 and other general exclusions or limitations included in a health insurance policy to the 21 same extent as other health care services covered by the policy; and 22 (4) must cover medically necessary treatment that is coordinated with 23 an education program, but may not be contingent on the coordination of treatment 24 with an education program. 25 (c) This section does not limit benefits that are otherwise available to an 26 individual under a health care insurance plan. 27 (d) A health care insurer may not refuse to deliver, execute, issue, amend, or 28 renew coverage to an individual or terminate coverage because the individual is 29 diagnosed with or received treatment for autism spectrum disorders. 30 (e) In this section, 31 (1) "autism service provider" means an individual who is licensed,
01 certified, or registered by the applicable state licensing board or by a nationally 02 recognized certifying organization and who provides direct services to an individual 03 with an autism spectrum disorder; 04 (2) "autism spectrum disorders" means pervasive developmental 05 disorders, or a group of conditions having substantially the same characteristics as 06 pervasive developmental disorders, as defined in the American Psychiatric 07 Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR, as 08 amended or reissued from time to time; 09 (3) "health care insurance plan" has the meaning given in 10 AS 21.54.500; 11 (4) "health care insurer" has the meaning given in AS 21.54.500; 12 (5) "medically necessary" means any care, treatment, intervention, 13 service, or item prescribed by a licensed physician or psychologist in accordance with 14 accepted standards of practice that will, or is reasonably expected to, 15 (A) prevent the onset of an illness, condition, injury, or 16 disability; 17 (B) reduce or ameliorate the physical, mental, or developmental 18 effects of an illness, condition, injury, or disability; 19 (C) assist to achieve or maintain maximum functional capacity 20 in performing daily activities, taking into account both the functional capacity 21 of the individual and the functional capacity of other persons of the individual's 22 age. 23 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 24 read: 25 APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health 26 insurance policy that is offered, issued for delivery, delivered, or renewed on or after 27 January 1, 2012. 28 * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).