Senate Bill sb1010

    Florida Senate - 2006                                  SB 1010

    By Senator Geller





    31-263A-06

  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 a minor for

  7         autism spectrum disorder; defining the term

  8         "autism spectrum disorder"; authorizing an

  9         insurer or health maintenance organization to

10         confirm a diagnosis or review the

11         appropriateness of a treatment plan; limiting

12         the amount of annual coverage; providing that

13         the act does not affect the licensure of a

14         health care professional or impair the right to

15         reimbursement of a health care provider;

16         providing that the act fulfills an important

17         state interest; providing an effective date.

18  

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

20  

21         Section 1.  Health insurance coverage for autism

22  spectrum disorder.--

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

24  spectrum disorder" means a neurobiological condition that

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

26         (b)  Any health insurer or health maintenance

27  organization that issues major medical expense coverage in

28  this state may not exclude coverage prescribed by the

29  referring physician for the treatment of a minor for autism

30  spectrum disorder, including, but not limited to, coverage for

31  therapeutic evaluations and interventions, speech therapy,

                                  1

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






    Florida Senate - 2006                                  SB 1010
    31-263A-06




 1  occupational therapy, physical therapy, intensive early

 2  intervention, applied behavioral analysis, and Lovaas

 3  behavioral therapy.

 4         (2)  Coverage for autism spectrum disorder for a minor

 5  is subject to the same terms and conditions that the insurer

 6  or health maintenance organization applies to the treatment of

 7  other disorders. However, an insurer or health maintenance

 8  organization may confirm a diagnosis or review the

 9  appropriateness of a specific treatment plan in order to

10  ensure that coverage under this section is limited to

11  diagnostic and treatment services.

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

13  health maintenance organization for coverage for a minor under

14  this section may not exceed $10,000.

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

16  licensure of any health care professional and does not impair

17  any right to reimbursement which is otherwise guaranteed to a

18  health care provider.

19         Section 2.  The Legislature finds that the provisions

20  of this act fulfill an important state interest.

21         Section 3.  This act shall take effect July 1, 2006.

22  

23            *****************************************

24                          SENATE SUMMARY

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

31  

                                  2

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