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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.