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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).