00                            SENATE BILL NO. 250                                                                         
01 "An Act requiring insurance coverage for autism spectrum disorders, describing the                                      
02 method for establishing a treatment plan for those disorders, and defining the treatment                                
03 required 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 for the cost of                             
10       treatment required by this subsection must cover the treatment of the disorders                                   
11       prescribed by a licensed physician or psychologist and provided by an autism service                              
12       provider as identified in a treatment plan developed following a comprehensive                                    
13       evaluation. A treatment plan developed under this subsection must identify the                                    
14       medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative                           

01       care, and therapeutic care required. In this subsection,                                                          
02                 (1)  "rehabilitative care" means professional counseling, guidance                                      
03       services, and treatment programs, including applied behavior analysis necessary to                                
04       develop, restore, and maintain the functioning of an individual to the maximum extent                             
05       practicable; in this paragraph, "applied behavior analysis" means the design,                                     
06       implementation, and evaluation of environmental modifications, using behavioral                                   
07       stimuli and consequences, including direct observation, measurement, and functional                               
08       analysis of the relationship between environment and behavior, to produce socially                                
09       significant improvement in human behavior or to prevent the loss of an attained skill                             
10       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)  must provide a maximum benefit of $36,000 a year, adjusted                                         
18       annually, beginning January 1, 2012, by the percentage change in the Consumer Price                               
19       Index for all urban consumers compiled by the United States Department of Labor,                                  
20       Bureau of Labor Statistics; payments made by an insurer on behalf of a covered                                    
21       individual for treatment of a medical condition unrelated to the individual's autism                              
22       spectrum disorder may not be applied toward the maximum benefit established in this                               
23       paragraph;                                                                                                        
24                 (3)  may not limit the number of visits to an autism service provider for                               
25       treatment;                                                                                                        
26                 (4)  is subject to copayment, deductible, and coinsurance provisions,                                   
27       and other general exclusions or limitations included in a health insurance policy to the                          
28       same extent as other health care services covered by the policy; and                                              
29                 (5)  must cover medically necessary treatment that is coordinated with                                  
30       an education program, but may not be contingent on the coordination of treatment                                  
31       with an education program.                                                                                        

01            (c)  This section does not limit benefits that are otherwise available to an                                 
02       individual under a health care insurance plan.                                                                    
03            (d)  A health care insurer may not terminate, refuse to deliver, execute, issue,                             
04       amend, or renew coverage to an individual because the individual is diagnosed with or                             
05       received treatment of autism spectrum disorders.                                                                  
06            (e)  In this section,                                                                                        
07                 (1)  "autism service provider" means an individual who provides direct                                  
08       services to a person with autism spectrum disorder, is licensed, certified, or registered                         
09       by the applicable state licensing board or by a nationally recognized organization, and                           
10       who qualifies under one of the following:                                                                         
11                      (A)  has received a doctoral degree with a specialty in                                            
12            psychiatry, medicine, or clinical psychology, is actively licensed in the                                    
13            specialty, and has one year of direct experience in behavioral therapies that are                            
14            consistent with best practice and research on effectiveness for people with                                  
15            autism spectrum disorders;                                                                                   
16                      (B)  has received a doctoral degree in behavioral or health                                        
17            sciences and has completed one year of experience in behavioral therapies that                               
18            are consistent with best practice and research on effectiveness for people with                              
19            autism spectrum disorders;                                                                                   
20                      (C)  has received a master's degree or higher in behavioral                                        
21            sciences and is nationally certified as a board certified behavior analyst or                                
22            certified by a similar nationally recognized organization;                                                   
23                      (D)  has received a master's degree or higher in behavior or                                       
24            health sciences, is licensed as a physical therapist, occupational therapist, or                             
25            speech-language pathologist, and has completed one year of directly                                          
26            supervised experience in behavioral therapies for people with autism spectrum                                
27            disorders;                                                                                                   
28                      (E)  has received a baccalaureate degree or higher in behavioral                                   
29            sciences and is nationally certified as a board certified associate behavior                                 
30            analyst or certified by a similar nationally recognized organization;                                        
31                 (2)  "autism spectrum disorders" are those defined by the current                                       

01       edition of the American Psychiatric Association's Diagnostic and Statistical Manual of                            
02       Mental Disorders, including autistic disorder, Asperger's disorder, and pervasive                                 
03       developmental disorder not otherwise specified;                                                                   
04                 (3)  "health care insurance plan" has the meaning given in                                              
05       AS 21.54.500;                                                                                                     
06                 (4)  "health care insurer" has the meaning given in AS 21.54.500;                                       
07                 (5)  "medically necessary" means any care, treatment, intervention,                                     
08       service, or item prescribed by a licensed physician or psychologist in accordance with                            
09       accepted standards of practice that will, or is reasonably expected to,                                           
10                      (A)  prevent the onset of an illness, condition, injury, or                                        
11            disability;                                                                                                  
12                      (B)  reduce or ameliorate the physical, mental, or developmental                                   
13            effects of an illness, condition, injury, or disability;                                                     
14                      (C)  assist in achieving or maintaining maximum functional                                         
15            capacity in performing daily activities.                                                                     
16    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
17 read:                                                                                                                   
18       APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health                                   
19 insurance policy that is offered, issued for delivery, delivered, or renewed on or after                                
20 January 1, 2011.                                                                                                        
21    * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).