Senate Bill sb0138

    Florida Senate - 2005                                   SB 138

    By Senator Geller





    31-124-05

  1                      A bill to be entitled

  2         An act relating to health insurance coverage

  3         for autism spectrum disorder; requiring a

  4         health insurer or health maintenance

  5         organization that offers major medical coverage

  6         to include coverage for treating autism

  7         spectrum disorder; defining the term "autism

  8         spectrum disorder"; authorizing an insurer or

  9         health maintenance organization to confirm a

10         diagnosis or review the appropriateness of a

11         treatment plan; limiting the amount of annual

12         coverage; providing that the act does not

13         affect the licensure of a health care

14         professional or impair the right to

15         reimbursement of a health care provider; making

16         a legislative finding that the act fulfills an

17         important state interest; providing an

18         effective date.

19  

20  Be It Enacted by the Legislature of the State of Florida:

21  

22         Section 1.  Health insurance coverage for autism

23  spectrum disorder.--

24         (1)(a)  As used in this section, the term "autism

25  spectrum disorder" means a neurobiological condition that

26  includes autism, Asperger syndrome, and Rett's syndrome.

27         (b)  Any health insurer or health maintenance

28  organization that issues major medical expense coverage in

29  this state may not exclude coverage prescribed by the

30  referring physician for the treatment of autism spectrum

31  disorder, including, but not limited to, coverage for

                                  1

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2005                                   SB 138
    31-124-05




 1  therapeutic evaluations and interventions, speech therapy,

 2  occupational therapy, physical therapy, intensive early

 3  intervention, applied behavioral analysis, and Lovaas

 4  behavioral therapy.

 5         (2)  Coverage for autism spectrum disorder is subject

 6  to the same terms and conditions that the insurer or health

 7  maintenance organization applies to the treatment of other

 8  disorders. However, an insurer or health maintenance

 9  organization may confirm a diagnosis or review the

10  appropriateness of a specific treatment plan in order to

11  ensure that coverage under this section is limited to

12  diagnostic and treatment services.

13         (3)  The total annual payments by a health insurer or

14  health maintenance organization for coverage under this

15  section may not exceed $10,000.

16         (4)  This section does not affect the scope of

17  licensure of any health care professional and does not impair

18  any right to reimbursement which is otherwise guaranteed to a

19  health care provider.

20         Section 2.  The Legislature finds that the provisions

21  of this act fulfill an important state interest.

22         Section 3.  This act shall take effect July 1, 2005.

23  

24            *****************************************

25                          SENATE SUMMARY

26    Requires a health insurer or health maintenance
      organization to include autism spectrum disorders within
27    the coverage for major medical expenses. Requires
      coverage for certain types of evaluations and
28    interventions for such disorders. Authorizes the insurer
      or health maintenance organization to confirm a diagnosis
29    or review the appropriateness of treatment. Limits the
      coverage to $10,000 per year. Provides that the act does
30    not affect the scope of a health care professional's
      licensure or impair a health care provider's right to
31    reimbursement.

                                  2

CODING: Words stricken are deletions; words underlined are additions.