Enrolled SB 74: 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; establishing the Comprehensive Autism Early Diagnosis and Treatment Task Force; and providing for an effective date.
00Enrolled SB 74 01 Requiring insurance coverage for autism spectrum disorders, describing the method for 02 establishing a covered treatment plan for those disorders, and defining the covered treatment 03 for those disorders; establishing the Comprehensive Autism Early Diagnosis and Treatment 04 Task Force; and providing for an effective date. 05 _______________ 06 * Section 1. AS 21.42 is amended by adding a new section to read: 07 Sec. 21.42.397. Coverage for autism spectrum disorders. (a) Except for a 08 fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, 09 or renews a health care insurance plan in this state shall provide coverage for the costs 10 of the diagnosis and treatment of autism spectrum disorders. Coverage required by this 11 subsection must include treatment prescribed by a licensed physician, psychologist, or 12 advanced nurse practitioner, provided by or supervised by an autism service provider, 13 and as identified in a treatment plan developed following a comprehensive evaluation. 14 Covered treatment includes medically necessary pharmacy care, psychiatric care,
01 psychological care, habilitative or rehabilitative care, and therapeutic care. In this 02 subsection, 03 (1) "habilitative or rehabilitative care" means professional counseling, 04 guidance services, and treatment programs necessary to develop, restore, or maintain 05 the functioning of an individual to the maximum extent practicable, including applied 06 behavior analysis or other structured behavioral therapies; in this paragraph, "applied 07 behavior analysis" means the design, implementation, and evaluation of environmental 08 modifications, using behavioral stimuli and consequences, including direct 09 observation, measurement, and functional analysis of the relationship between 10 environment and behavior, to produce socially significant improvement in human 11 behavior or to prevent the loss of an attained skill or function; 12 (2) "therapeutic care" means services provided by or under the 13 supervision of a speech-language pathologist licensed under AS 08.11 or an 14 occupational therapist or physical therapist licensed under AS 08.84. 15 (b) Coverage under this section 16 (1) is required to be provided only to individuals under 21 years of 17 age; 18 (2) may not limit the number of visits to an autism service provider for 19 treatment; 20 (3) is subject to copayment, deductible, and coinsurance provisions, 21 and other general exclusions or limitations included in a health insurance policy to the 22 same extent as other health care services covered by the policy; and 23 (4) must cover medically necessary treatment that is coordinated with 24 an education program, but may not be contingent on the coordination of treatment 25 with an education program. 26 (c) An insurer providing health care insurance to a small employer in the 27 group market with 20 or fewer employees is not required to provide insurance 28 coverage to the small employer that includes the coverage required under (a) of this 29 section. 30 (d) The director may waive the coverage required in this section for an insurer 31 providing health care insurance to a small employer in the group market with 21 - 25
01 employees if the small employer demonstrates to the director by actual claims 02 experience over any consecutive 12-month period that compliance with this section 03 has increased the premium cost of the small employer's health insurance policy by 04 three percent or more during the consecutive 12-month period. 05 (e) This section does not limit benefits that are otherwise available to an 06 individual under a health care insurance plan. 07 (f) A health care insurer may not refuse to deliver, execute, issue, amend, or 08 renew coverage to an individual or terminate coverage because the individual is 09 diagnosed with or has received treatment for autism spectrum disorders. 10 (g) In this section, 11 (1) "autism service provider" means an individual who is licensed, 12 certified, or registered by the applicable state licensing board or by a nationally 13 recognized certifying organization and who provides direct services to an individual 14 with an autism spectrum disorder; 15 (2) "autism spectrum disorders" means pervasive developmental 16 disorders, or a group of conditions having substantially the same characteristics as 17 pervasive developmental disorders, as defined in the American Psychiatric 18 Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR, as 19 amended or reissued from time to time; 20 (3) "health care insurance plan" has the meaning given in 21 AS 21.54.500; 22 (4) "health care insurer" has the meaning given in AS 21.54.500; 23 (5) "medically necessary" means any care, treatment, intervention, 24 service, or item prescribed by a licensed physician, psychologist, or advanced nurse 25 practitioner in accordance with accepted standards of practice that will, or is 26 reasonably expected to, 27 (A) prevent the onset of an illness, condition, injury, or 28 disability; 29 (B) reduce or ameliorate the physical, mental, or developmental 30 effects of an illness, condition, injury, or disability; 31 (C) assist to achieve or maintain maximum functional capacity
01 in performing daily activities, taking into account both the functional capacity 02 of the individual and the functional capacity of other persons of the individual's 03 age. 04 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 05 read: 06 AUTISM TASK FORCE. (a) The Comprehensive Autism Early Diagnosis and 07 Treatment Task Force is created in the legislative branch for the purpose of making 08 recommendations for the development of a statewide comprehensive plan to support early 09 diagnosis and treatment of autism and studying the effects of the state's providing insurance 10 coverage for autism spectrum disorder. 11 (b) The task force consists of nine members who, except for those in (1) and (2) of 12 this subsection, shall be appointed jointly by the President of the Senate and the Speaker of 13 the House of Representatives as follows: 14 (1) one senator selected by the President of the Senate, who shall serve as co- 15 chair; 16 (2) one representative selected by the Speaker of the House of 17 Representatives, who shall serve as co-chair; 18 (3) one member representing mental health service providers; 19 (4) one member from the Governor's Council on Disabilities and Special 20 Education (AS 47.80.030); 21 (5) the commissioner of health and social services or the commissioner's 22 designee; 23 (6) the commissioner of administration or the commissioner's designee; 24 (7) the director of the division of insurance, Department of Commerce, 25 Community, and Economic Development, or the director's designee; 26 (8) one member representing a private insurance provider who offers health- 27 insurance-related services in the state; and 28 (9) one parent or guardian of an autistic child. 29 (c) The task force shall, not later than January 15, 2013, submit a report to the 30 legislature and the Governor. The report must include 31 (1) policy options to achieve a comprehensive autism spectrum disorder early
01 diagnosis and treatment program that results in coverage to the greatest number of residents in 02 the state; 03 (2) recommendations to the legislature and the Governor that include draft 04 legislation required to achieve the policy options proposed by the task force; 05 (3) an evaluation of the fiscal effect of the policy options proposed by the task 06 force that includes a five-year projection of both public sector and private sector costs and 07 expenditures; 08 (4) an analysis of how the implementation of P.L. 111-148 (Patient Protection 09 and Affordable Care Act) is expected to affect the options, recommendations, and fiscal 10 evaluations of the task force. 11 (d) The task force shall meet as needed during the interim following the Second 12 Regular Session in 2012. 13 (e) The task force may request administrative and technical support from the 14 Department of Education and Early Development. 15 (f) Members of the task force shall serve without compensation but are entitled to per 16 diem and travel expenses authorized for boards and commissions under AS 39.20.180. 17 (g) The task force terminates on January 15, 2013, unless extended. 18 * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 19 read: 20 APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health 21 insurance policy that is offered, issued for delivery, delivered, or renewed on or after 22 January 1, 2013. 23 * Sec. 4. Section 2 of this Act takes effect immediately under AS 01.10.070(c). 24 * Sec. 5. Except as provided in sec. 4 of this Act, this Act takes effect January 1, 2013.