Florida Senate - 2009                       CS for CS for SB 308
       
       
       
       By the Committees on Banking and Insurance; and Health
       Regulation; and Senator Ring
       
       
       
       597-05047-09                                           2009308c2
    1                        A bill to be entitled                      
    2         An act relating to developmental disabilities;
    3         creating s. 381.986, F.S.; requiring that a physician
    4         refer a minor to an appropriate specialist for
    5         screening for autism spectrum disorder or other
    6         developmental disability and inform the parent or
    7         legal guardian of the right to direct access to that
    8         specialist under certain circumstances; defining the
    9         term “appropriate specialist”; amending ss. 627.6686
   10         and 641.31098, F.S.; defining the term “developmental
   11         disability”; providing health insurance coverage for
   12         individuals with developmental disabilities; requiring
   13         certain insurers and health maintenance organizations
   14         to provide direct patient access to an appropriate
   15         specialist for screening, evaluation of, or diagnosis
   16         for autism spectrum disorder or other developmental
   17         disabilities; defining the term “direct patient
   18         access”; requiring the insurer’s policy or the health
   19         maintenance organization’s contract to provide a
   20         minimum number of visits per year for the screening,
   21         evaluation, or diagnosis for autism spectrum disorder
   22         or other developmental disabilities; providing an
   23         effective date.
   24  
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Section 381.986, Florida Statutes, is created to
   28  read:
   29         381.986Screening for autism spectrum disorder and other
   30  developmental disabilities.—
   31         (1)If the parent or legal guardian of a minor who is an
   32  eligible individual, as defined in s. 627.6686 or s. 641.31098,
   33  believes that the minor exhibits symptoms of autism spectrum
   34  disorder or other developmental disability, the parent or legal
   35  guardian may report his or her observation to a state-licensed
   36  primary care physician, other than an obstetrician or
   37  gynecologist. The physician shall immediately refer the minor to
   38  an appropriate specialist for further screening if, after
   39  examination and initial screening, the referral is clinically
   40  indicated. The physician shall also inform the parent or legal
   41  guardian of the right to direct access to an appropriate
   42  specialist for screening, evaluation, or diagnosis for autism
   43  spectrum disorder or other developmental disability. This
   44  section does not apply to a physician providing care under s.
   45  395.1041.
   46         (2)As used in this section, the term “appropriate
   47  specialist” means a qualified professional who is experienced in
   48  the evaluation of autism spectrum disorder or other
   49  developmental disabilities, who has training in validated
   50  diagnostic tools, and includes, but is not limited to, a person
   51  who is licensed in this state as:
   52         (a)A psychologist.
   53         (b)A psychiatrist.
   54         (c)A neurologist.
   55         (d)A developmental or behavioral pediatrician who
   56  specializes in child neurology.
   57         (e)A speech language pathologist.
   58         (f)An occupational therapist.
   59         (g)A mental health professional licensed under chapter
   60  491.
   61         (h)A professional whose licensure is deemed appropriate by
   62  the Children’s Medical Services Early Steps Program in the
   63  Department of Health.
   64         Section 2. Subsections (2) and (3) of section 627.6686,
   65  Florida Statutes, are amended, and subsection (11) is added to
   66  that section, to read:
   67         627.6686 Coverage for individuals with autism spectrum
   68  disorder required; exception.—
   69         (2) As used in this section, the term:
   70         (a) “Applied behavior analysis” means the design,
   71  implementation, and evaluation of environmental modifications,
   72  using behavioral stimuli and consequences, to produce socially
   73  significant improvement in human behavior, including, but not
   74  limited to, the use of direct observation, measurement, and
   75  functional analysis of the relations between environment and
   76  behavior.
   77         (b) “Autism spectrum disorder” means any of the following
   78  disorders as defined in the most recent edition of the
   79  Diagnostic and Statistical Manual of Mental Disorders of the
   80  American Psychiatric Association:
   81         1. Autistic disorder.
   82         2. Asperger’s syndrome.
   83         3. Pervasive developmental disorder not otherwise
   84  specified.
   85         (c)“Developmental disability” means a disorder or syndrome
   86  attributable to retardation, cerebral palsy, autism, spina
   87  bifida, Down syndrome, or Prader-Willi syndrome that manifests
   88  before the age of 18 years old and constitutes a substantial
   89  handicap that can reasonably be expected to continue
   90  indefinitely. The term:
   91         1.“Retardation” means significantly subaverage general
   92  intellectual functioning existing concurrently with deficits in
   93  adaptive behavior which manifests before the age of 18 years old
   94  and can reasonably be expected to continue indefinitely. As used
   95  in this subparagraph, the term “significantly subaverage general
   96  intellectual functioning” means performance that is two or more
   97  standard deviations from the mean score on a standardized
   98  intelligence test specified in the rules of the agency. As used
   99  in this subparagraph, the term “adaptive behavior” means the
  100  effectiveness or degree with which an individual meets the
  101  standards of personal independence and social responsibility
  102  expected of his or her age, cultural group, and community.
  103         2.“Cerebral palsy” means a group of disabling symptoms of
  104  extended duration which results from damage to the developing
  105  brain that may occur before, during, or after birth and that
  106  results in the loss or impairment of control over voluntary
  107  muscles. As used in this subparagraph, cerebral palsy does not
  108  include those symptoms or impairments resulting solely from a
  109  stroke.
  110         3.“Autism” means a pervasive, neurologically based
  111  developmental disability of extended duration which causes
  112  severe learning, communication, and behavior disorders that
  113  occur during infancy or childhood. Individuals with autism
  114  exhibit impairment in reciprocal social interaction, impairment
  115  in verbal and nonverbal communication and imaginative ability,
  116  and a markedly restricted repertoire of activities and
  117  interests.
  118         4.“Spina bifida” means a medical diagnosis of spina bifida
  119  cystica or myelomeningocele.
  120         5.“Down syndrome” means a disorder caused by the presence
  121  of an extra chromosome 21.
  122         6.“Prader-Willi syndrome” means an inherited condition
  123  typified by neonatal hypotonia with failure to thrive,
  124  hyperphagia, or an excessive drive to eat which leads to obesity
  125  usually at 18 to 36 months of age, mild to moderate mental
  126  retardation, hypogonadism, short stature, mild facial
  127  dysmorphism, and a characteristic neurobehavior.
  128         (d)(c) “Eligible individual” means an individual under 18
  129  years of age or an individual 18 years of age or older who is in
  130  high school and who has been diagnosed as having a developmental
  131  disability at 8 years of age or younger.
  132         (e)(d) “Health insurance plan” means a group health
  133  insurance policy or group health benefit plan offered by an
  134  insurer which includes the state group insurance program
  135  provided under s. 110.123. The term does not include a any
  136  health insurance plan offered in the individual market, a any
  137  health insurance plan that is individually underwritten, or a
  138  any health insurance plan provided to a small employer.
  139         (f)(e) “Insurer” means an insurer providing health
  140  insurance coverage, which is licensed to engage in the business
  141  of insurance in this state and is subject to insurance
  142  regulation.
  143         (3) A health insurance plan issued or renewed on or after
  144  April 1, 2009, shall provide coverage to an eligible individual
  145  for:
  146         (a) Well-baby and well-child screening for diagnosing the
  147  presence of autism spectrum disorder or other developmental
  148  disability.
  149         (b) Treatment of autism spectrum disorder or other
  150  developmental disability through speech therapy, occupational
  151  therapy, physical therapy, and applied behavior analysis.
  152  Applied behavior analysis services shall be provided by an
  153  individual certified pursuant to s. 393.17 or an individual
  154  licensed under chapter 490 or chapter 491.
  155         (11)Notwithstanding any provision of this section, an
  156  insurer shall provide direct patient access for screening,
  157  evaluation of, or diagnosis for autism spectrum disorder or
  158  other developmental disability to an appropriate specialist, as
  159  defined in s. 381.986. As used in this subsection, the term
  160  “direct patient access” means the ability of a subscriber or
  161  insured to obtain services from an in-network provider without a
  162  referral or other authorization before receiving services.
  163  Pursuant to this subsection, the insurer’s policy must provide a
  164  minimum of three visits per policy year for the screening,
  165  evaluation, or diagnosis for autism spectrum disorder or other
  166  developmental disability.
  167         Section 3. Subsections (2) and (3) of section 641.31098,
  168  Florida Statutes, are amended, and subsection (10) is added to
  169  that section, to read:
  170         641.31098 Coverage for individuals with developmental
  171  disabilities.—
  172         (2) As used in this section, the term:
  173         (a) “Applied behavior analysis” means the design,
  174  implementation, and evaluation of environmental modifications,
  175  using behavioral stimuli and consequences, to produce socially
  176  significant improvement in human behavior, including, but not
  177  limited to, the use of direct observation, measurement, and
  178  functional analysis of the relations between environment and
  179  behavior.
  180         (b) “Autism spectrum disorder” means any of the following
  181  disorders as defined in the most recent edition of the
  182  Diagnostic and Statistical Manual of Mental Disorders of the
  183  American Psychiatric Association:
  184         1. Autistic disorder.
  185         2. Asperger’s syndrome.
  186         3. Pervasive developmental disorder not otherwise
  187  specified.
  188         (c)“Developmental disability” means a disorder or syndrome
  189  attributable to retardation, cerebral palsy, autism, spina
  190  bifida, Down syndrome, or Prader-Willi syndrome that manifests
  191  before the age of 18 years old and constitutes a substantial
  192  handicap that can reasonably be expected to continue
  193  indefinitely. The term:
  194         1.“Retardation” means significantly subaverage general
  195  intellectual functioning existing concurrently with deficits in
  196  adaptive behavior which manifests before the age of 18 years old
  197  and can reasonably be expected to continue indefinitely. As used
  198  in this subparagraph, the term “significantly subaverage general
  199  intellectual functioning” means performance that is two or more
  200  standard deviations from the mean score on a standardized
  201  intelligence test specified in the rules of the agency. As used
  202  in this subparagraph, the term “adaptive behavior” means the
  203  effectiveness or degree with which an individual meets the
  204  standards of personal independence and social responsibility
  205  expected of his or her age, cultural group, and community.
  206         2.“Cerebral palsy” means a group of disabling symptoms of
  207  extended duration which results from damage to the developing
  208  brain that may occur before, during, or after birth and that
  209  results in the loss or impairment of control over voluntary
  210  muscles. As used in this subparagraph, cerebral palsy does not
  211  include those symptoms or impairments resulting solely from a
  212  stroke.
  213         3.“Autism” means a pervasive, neurologically based
  214  developmental disability of extended duration which causes
  215  severe learning, communication, and behavior disorders that
  216  occur during infancy or childhood. Individuals with autism
  217  exhibit impairment in reciprocal social interaction, impairment
  218  in verbal and nonverbal communication and imaginative ability,
  219  and a markedly restricted repertoire of activities and
  220  interests.
  221         4.“Spina bifida” means a medical diagnosis of spina bifida
  222  cystica or myelomeningocele.
  223         5.“Down syndrome” means a disorder caused by the presence
  224  of an extra chromosome 21.
  225         6.“Prader-Willi syndrome” means an inherited condition
  226  typified by neonatal hypotonia with failure to thrive,
  227  hyperphagia, or an excessive drive to eat which leads to obesity
  228  usually at 18 to 36 months of age, mild to moderate mental
  229  retardation, hypogonadism, short stature, mild facial
  230  dysmorphism, and a characteristic neurobehavior.
  231         (d)(c) “Eligible individual” means an individual under 18
  232  years of age or an individual 18 years of age or older who is in
  233  high school and who has been diagnosed as having a developmental
  234  disability at 8 years of age or younger.
  235         (e)(d) “Health maintenance contract” means a group health
  236  maintenance contract offered by a health maintenance
  237  organization. The This term does not include a health
  238  maintenance contract offered in the individual market, a health
  239  maintenance contract that is individually underwritten, or a
  240  health maintenance contract provided to a small employer.
  241         (3) A health maintenance contract issued or renewed on or
  242  after April 1, 2009, shall provide coverage to an eligible
  243  individual for:
  244         (a) Well-baby and well-child screening for diagnosing the
  245  presence of autism spectrum disorder or other developmental
  246  disability.
  247         (b) Treatment of autism spectrum disorder or other
  248  developmental disability through speech therapy, occupational
  249  therapy, physical therapy, and applied behavior analysis
  250  services. Applied behavior analysis services shall be provided
  251  by an individual certified pursuant to s. 393.17 or an
  252  individual licensed under chapter 490 or chapter 491.
  253         (10)Notwithstanding any provision of this section, a
  254  health maintenance organization shall provide direct patient
  255  access for screening, evaluation of, or diagnosis for autism
  256  spectrum disorder or other developmental disability to an
  257  appropriate specialist, as defined in s. 381.986. As used in
  258  this subsection, the term “direct patient access” means the
  259  ability of a subscriber or insured to obtain services from an
  260  in-network provider without a referral or other authorization
  261  before receiving services. Pursuant to this subsection, the
  262  health maintenance organization’s contract must provide a
  263  minimum of three visits per policy year for the screening,
  264  evaluation, or diagnosis for autism spectrum disorder or other
  265  developmental disability.
  266         Section 4. This act shall take effect July 1, 2009.