HCS SB 74(RLS): "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 HOUSE CS FOR SENATE BILL NO. 74(RLS) 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, psychologist, or 11 advanced nurse practitioner, provided by or supervised by an autism service provider, 12 and as identified in a treatment plan developed following a comprehensive evaluation. 13 Covered treatment includes medically necessary pharmacy care, psychiatric care, 14 psychological care, habilitative or rehabilitative care, and therapeutic care. In this
01 subsection, 02 (1) "habilitative or rehabilitative care" means professional counseling, 03 guidance services, and treatment programs necessary to develop, restore, or maintain 04 the functioning of an individual to the maximum extent practicable, including applied 05 behavior analysis or other structured behavioral therapies; in this paragraph, "applied 06 behavior analysis" means the design, implementation, and evaluation of environmental 07 modifications, using behavioral stimuli and consequences, including direct 08 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) An insurer providing health care insurance to a small employer in the 26 group market with 20 or fewer employees is not required to provide insurance 27 coverage to the small employer that includes the coverage required under (a) of this 28 section. 29 (d) The director may waive the coverage required in this section for an insurer 30 providing health care insurance to a small employer in the group market with 21 - 25 31 employees if the small employer demonstrates to the director by actual claims
01 experience over any consecutive 12-month period that compliance with this section 02 has increased the premium cost of the small employer's health insurance policy by 03 three percent or more during the consecutive 12-month period. 04 (e) This section does not limit benefits that are otherwise available to an 05 individual under a health care insurance plan. 06 (f) A health care insurer may not refuse to deliver, execute, issue, amend, or 07 renew coverage to an individual or terminate coverage because the individual is 08 diagnosed with or has received treatment for autism spectrum disorders. 09 (g) In this section, 10 (1) "autism service provider" means an individual who is licensed, 11 certified, or registered by the applicable state licensing board or by a nationally 12 recognized certifying organization and who provides direct services to an individual 13 with an autism spectrum disorder; 14 (2) "autism spectrum disorders" means pervasive developmental 15 disorders, or a group of conditions having substantially the same characteristics as 16 pervasive developmental disorders, as defined in the American Psychiatric 17 Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR, as 18 amended or reissued from time to time; 19 (3) "health care insurance plan" has the meaning given in 20 AS 21.54.500; 21 (4) "health care insurer" has the meaning given in AS 21.54.500; 22 (5) "medically necessary" means any care, treatment, intervention, 23 service, or item prescribed by a licensed physician, psychologist, or advanced nurse 24 practitioner in accordance with accepted standards of practice that will, or is 25 reasonably expected to, 26 (A) prevent the onset of an illness, condition, injury, or 27 disability; 28 (B) reduce or ameliorate the physical, mental, or developmental 29 effects of an illness, condition, injury, or disability; 30 (C) assist to achieve or maintain maximum functional capacity 31 in performing daily activities, taking into account both the functional capacity
01 of the individual and the functional capacity of other persons of the individual's 02 age. 03 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 04 read: 05 APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health 06 insurance policy that is offered, issued for delivery, delivered, or renewed on or after 07 January 1, 2013. 08 * Sec. 3. This Act takes effect January 1, 2013.