((LATE FILED FOR: 4/30/2008 8:30:00 AM))Amendment
Bill No. CS/CS/CS/SB 2654
Amendment No. 552837
CHAMBER ACTION
Senate House
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1Representative Coley offered the following:
2
3     Amendment to Amendment (940817) (with title amendment)
4     Remove lines 268-762 and insert:
5     Section 7.  Subsections (6) through (26) of section
6409.811, Florida Statutes, are renumbered as subsections (7)
7through (27), respectively, and a new subsection (6) is added to
8that section, to read:
9     409.811  Definitions relating to Florida Kidcare Act.--As
10used in ss. 409.810-409.820, the term:
11     (6)  "Autism spectrum disorder" means any of the following
12disorders as defined with most recent edition of the Diagnostic
13and Statistical Manual of Mental Disorders of the American
14Psychiatric Association:
15     1.  Autistic disorder;
16     2.  Asperger syndrome; or
17     3.  Pervasive developmental disorder not otherwise
18specified.
19     Section 8.  Paragraphs (r) through (v) of subsection (2) of
20section 409.815, Florida Statutes, are redesignated as
21paragraphs (s) through (w), respectively, present paragraphs
22(o), (r), and (u) are amended, and a new paragraph (r) is added
23to that subsection, to read:
24     409.815  Health benefits coverage; limitations.--
25     (2)  BENCHMARK BENEFITS.--In order for health benefits
26coverage to qualify for premium assistance payments for an
27eligible child under ss. 409.810-409.820, the health benefits
28coverage, except for coverage under Medicaid and Medikids, must
29include the following minimum benefits, as medically necessary.
30     (o)  Therapy services.--Covered services include
31habilitative and rehabilitative services, including
32occupational, physical, respiratory, and speech therapies, with
33the following limitations:
34     1.  Rehabilitative services are limited to:
35     a.1.  Services must be for Short-term rehabilitation when
36where significant improvement in the enrollee's condition will
37result; and
38     b.2.  Services shall be limited to Not more than 24
39treatment sessions within a 60-day period per episode or injury,
40with the 60-day period beginning with the first treatment.
41     2.  Effective October 1, 2009, habilitative services shall
42be offered and are limited to:
43     a.  Habilitation when improvements in and maintenance of
44human behavior, skill acquisition, and communication will
45result; and
46     b.  Enrollees that are diagnosed with a developmental
47disability as defined in s. 393.063 or autism spectrum disorder
48as defined in paragraph (r)1.
49     (r)  Behavior analysis services.--Effective October 1,
502009, behavior analysis and behavior assistant services shall be
51covered for enrollees that are diagnosed with a developmental
52disability as defined in s. 393.063 or autism spectrum disorder.
53For purposes of this paragraph:
54     1.  "Autism spectrum disorder" means any of the following
55disorders as defined with most recent edition of the Diagnostic
56and Statistical Manual of Mental Disorders of the American
57Psychiatric Association:
58     a.  Autistic disorder;
59     b.  Asperger syndrome; or
60     c.  Pervasive developmental disorder not otherwise
61specified.
62     2.  "Behavior analysis" means the design, implementation,
63and evaluation of instructional and environmental modifications
64to produce socially significant improvements in human behavior
65through skill acquisition and the reduction of problematic
66behavior. Behavior analysis shall be provided by an individual
67certified pursuant to s. 393.17 or an individual licensed under
68chapter 490 or chapter 491.
69     3.  "Behavior assistant services" means services provided
70by an individual with specific training to assist in carrying
71out plans designed by a behavior analyst.
72     (s)(r)  Lifetime maximum and limitations.--Health benefits
73coverage obtained under ss. 409.810-409.820 shall pay an
74enrollee's covered expenses at a lifetime maximum of $1 million
75per covered child. However, coverage for the combination of
76behavior analysis services and habilitative therapy services for
77recipients diagnosed with a developmental disability as defined
78in s. 393.063 or autism spectrum disorder as defined in
79paragraph (r)1. shall be limited to $36,000 annually and may not
80exceed $108,000 in total lifetime benefits. Without prior
81authorization by the Florida Healthy Kids plan, not more than 12
82percent of the annual maximum amount for combined habilitative
83therapy and behavior analysis services may be used on a monthly
84basis.
85     (v)(u)  Enhancements to minimum requirements.--
86     1.  This section sets the minimum benefits that must be
87included in any health benefits coverage, other than Medicaid or
88Medikids coverage, offered under ss. 409.810-409.820. Health
89benefits coverage may include additional benefits not included
90under this subsection, but may not include benefits excluded
91under paragraph (t) (s).
92     2.  Health benefits coverage may extend any limitations
93beyond the minimum benefits described in this section.
94
95Except for the Children's Medical Services Network, the agency
96may not increase the premium assistance payment for either
97additional benefits provided beyond the minimum benefits
98described in this section or the imposition of less restrictive
99service limitations.
100     Section 9.  Paragraph (b) of subsection (1) of section
101409.818, Florida Statutes, is amended to read:
102     409.818  Administration.--In order to implement ss.
103409.810-409.820, the following agencies shall have the following
104duties:
105     (1)  The Department of Children and Family Services shall:
106     (b)  Establish and maintain the eligibility determination
107process under the program except as specified in subsection (5).
108The department shall directly, or through the services of a
109contracted third-party administrator, establish and maintain a
110process for determining eligibility of children for coverage
111under the program. The eligibility determination process must be
112used solely for determining eligibility of applicants for health
113benefits coverage under the program. The eligibility
114determination process must include an initial determination of
115eligibility for any coverage offered under the program, as well
116as a redetermination or reverification of eligibility each
117subsequent 12 6 months. Effective January 1, 1999, a child who
118has not attained the age of 5 and who has been determined
119eligible for the Medicaid program is eligible for coverage for
12012 months without a redetermination or reverification of
121eligibility. In conducting an eligibility determination, the
122department shall determine if the child has special health care
123needs. The department, in consultation with the Agency for
124Health Care Administration and the Florida Healthy Kids
125Corporation, shall develop procedures for redetermining
126eligibility which enable a family to easily update any change in
127circumstances which could affect eligibility. The department may
128accept changes in a family's status as reported to the
129department by the Florida Healthy Kids Corporation without
130requiring a new application from the family. Redetermination of
131a child's eligibility for Medicaid may not be linked to a
132child's eligibility determination for other programs.
133     Section 10.  Subsection (26) is added to section 409.906,
134Florida Statutes, to read:
135     409.906  Optional Medicaid services.--Subject to specific
136appropriations, the agency may make payments for services which
137are optional to the state under Title XIX of the Social Security
138Act and are furnished by Medicaid providers to recipients who
139are determined to be eligible on the dates on which the services
140were provided. Any optional service that is provided shall be
141provided only when medically necessary and in accordance with
142state and federal law. Optional services rendered by providers
143in mobile units to Medicaid recipients may be restricted or
144prohibited by the agency. Nothing in this section shall be
145construed to prevent or limit the agency from adjusting fees,
146reimbursement rates, lengths of stay, number of visits, or
147number of services, or making any other adjustments necessary to
148comply with the availability of moneys and any limitations or
149directions provided for in the General Appropriations Act or
150chapter 216. If necessary to safeguard the state's systems of
151providing services to elderly and disabled persons and subject
152to the notice and review provisions of s. 216.177, the Governor
153may direct the Agency for Health Care Administration to amend
154the Medicaid state plan to delete the optional Medicaid service
155known as "Intermediate Care Facilities for the Developmentally
156Disabled." Optional services may include:
157     (26)  HOME AND COMMUNITY-BASED SERVICES FOR AUTISM SPECTRUM
158DISORDER AND OTHER DEVELOPMENTAL DISABILITIES.--The agency is
159authorized to seek federal approval through a Medicaid waiver or
160a state plan amendment for the provision of occupational
161therapy, speech therapy, physical therapy, behavior analysis,
162and behavior assistant services to individuals who are 5 years
163of age and under and have a diagnosed developmental disability
164as defined in s. 393.063 or autism spectrum disorder as defined
165in s. 391.026(2)(r)1. Coverage for such services shall be
166limited to $36,000 annually and may not exceed $108,000 in total
167lifetime benefits. The agency shall submit an annual report
168beginning on January 1, 2009, to the President of the Senate,
169the Speaker of the House of Representatives, and the relevant
170committees of the Senate and the House of Representatives
171regarding progress on obtaining federal approval and
172recommendations for the implementation of these home and
173community-based services. The agency may not implement this
174subsection without prior legislative approval.
175     Section 11.  Section 456.0291, Florida Statutes, is created
176to read:
177     456.0291  Requirement for instruction on developmental
178disabilities.--
179     (1)(a)  The appropriate board shall require each person
180licensed or certified under part I of chapter 464, chapter 490,
181or chapter 491 to complete a 2-hour continuing education course,
182approved by the board, on developmental disabilities, as defined
183in s. 393.063, with the addition of autism spectrum disorder as
184defined in paragraph (r)1., as part of every third biennial
185relicensure or recertification. The course shall consist of
186information on the diagnosis and treatment of developmental
187disabilities and information on counseling and education of a
188parent whose child is diagnosed with a developmental disability,
189with an emphasis on autism spectrum disorder as defined in
190paragraph (r)1.
191     (b)  The Board of Medicine and the Board of Osteopathic
192Medicine shall require each physician with a primary care
193specialty of pediatrics to complete a 2-hour continuing
194education course, approved by the appropriate board, on
195developmental disabilities, as defined in s. 393.063, with the
196addition of autism spectrum disorder as defined in s.
197391.026(2)(r)1., as part of every third biennial relicensure.
198The course shall consist of information on the diagnosis and
199treatment of developmental disabilities and information on
200counseling and education of a parent whose child is diagnosed
201with a developmental disability, with an emphasis on autism
202spectrum disorder as defined in s. 391.026(2)(r)1..
203     (c)  Each such licensee or certificateholder shall submit
204confirmation of having completed the course, on a form provided
205by the board, when submitting fees for every third biennial
206renewal.
207     (d)  The board may approve additional equivalent courses
208that may be used to satisfy the requirements of paragraph (a).
209Each licensing board that requires a licensee to complete an
210educational course pursuant to this subsection may include the
211hours required for completion of the course in the total hours
212of continuing education required by law for such profession
213unless the continuing education requirements for such profession
214consist of fewer than 30 hours biennially.
215     (e)  Any person holding two or more licenses subject to the
216provisions of this subsection shall be permitted to show proof
217of having taken one board-approved course on developmental
218disabilities for purposes of relicensure or recertification for
219additional licenses.
220     (f)  Failure to comply with the requirements of this
221subsection shall constitute grounds for disciplinary action
222under each respective practice act and under s. 456.072(1)(k).
223In addition to discipline by the board, the licensee shall be
224required to complete such course.
225     (2)  Each board may adopt rules pursuant to ss. 120.536(1)
226and 120.54 to carry out the provisions of this section.
227     (3)  The department shall implement a plan to promote
228awareness of developmental disabilities, with a focus on autism
229spectrum disorder as defined in s. 391.026(2)(r)1., to
230physicians licensed under chapter 458 or chapter 459 and
231parents. The department shall develop the plan in consultation
232with organizations representing allopathic and osteopathic
233physicians, the Board of Medicine, the Board of Osteopathic
234Medicine, and nationally recognized organizations that promote
235awareness of developmental disabilities. The department's plan
236shall include the distribution of educational materials for
237parents, including a developmental assessment tool.
238     Section 12.  Paragraph (b) of subsection (2) and paragraph
239(b) of subsection (5) of section 624.91, Florida Statutes, are
240amended to read:
241     624.91  The Florida Healthy Kids Corporation Act.--
242     (2)  LEGISLATIVE INTENT.--
243     (b)  It is the intent of the Legislature that the Florida
244Healthy Kids Corporation serve as one of several providers of
245services to children eligible for medical assistance under Title
246XXI of the Social Security Act. Although the corporation may
247serve other children, the Legislature intends the primary
248recipients of services provided through the corporation be
249school-age children with a family income below 200 percent of
250the federal poverty level, who do not qualify for Medicaid. It
251is also the intent of the Legislature that state and local
252government Florida Healthy Kids funds be used to continue
253coverage, subject to specific appropriations in the General
254Appropriations Act, to children not eligible for federal
255matching funds under Title XXI.
256     (5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
257     (b)  The Florida Healthy Kids Corporation shall:
258     1.  Arrange for the collection of any family, local
259contributions, or employer payment or premium, in an amount to
260be determined by the board of directors, to provide for payment
261of premiums for comprehensive insurance coverage and for the
262actual or estimated administrative expenses.
263     2.  Arrange for the collection of any voluntary
264contributions to provide for payment of premiums for children
265who are not eligible for medical assistance under Title XXI of
266the Social Security Act.
267     3.  Subject to the provisions of s. 409.8134, accept
268voluntary supplemental local match contributions that comply
269with the requirements of Title XXI of the Social Security Act
270for the purpose of providing additional coverage in contributing
271counties under Title XXI.
272     4.  Establish the administrative and accounting procedures
273for the operation of the corporation.
274     5.  Establish, with consultation from appropriate
275professional organizations, standards for preventive health
276services and providers and comprehensive insurance benefits
277appropriate to children, provided that such standards for rural
278areas shall not limit primary care providers to board-certified
279pediatricians.
280     6.  Determine eligibility for children seeking to
281participate in the Title XXI-funded components of the Florida
282Kidcare program consistent with the requirements specified in s.
283409.814, as well as the non-Title-XXI-eligible children as
284provided in subsection (3).
285     7.  Establish procedures under which providers of local
286match to, applicants to and participants in the program may have
287grievances reviewed by an impartial body and reported to the
288board of directors of the corporation.
289     8.  Establish participation criteria and, if appropriate,
290contract with an authorized insurer, health maintenance
291organization, or third-party administrator to provide
292administrative services to the corporation.
293     9.  Establish enrollment criteria which shall include
294penalties or waiting periods of not fewer than 60 days for
295reinstatement of coverage upon voluntary cancellation for
296nonpayment of family premiums.
297     10.  Contract with authorized insurers or any provider of
298health care services, meeting standards established by the
299corporation, for the provision of comprehensive insurance
300coverage to participants. Such standards shall include criteria
301under which the corporation may contract with more than one
302provider of health care services in program sites. Health plans
303shall be selected through a competitive bid process. The Florida
304Healthy Kids Corporation shall purchase goods and services in
305the most cost-effective manner consistent with the delivery of
306quality medical care. The maximum administrative cost for a
307Florida Healthy Kids Corporation contract shall be 15 percent.
308For health care contracts, the minimum medical loss ratio for a
309Florida Healthy Kids Corporation contract shall be 85 percent.
310For dental contracts, the remaining compensation to be paid to
311the authorized insurer or provider under a Florida Healthy Kids
312Corporation contract shall be no less than an amount which is 85
313percent of premium; to the extent any contract provision does
314not provide for this minimum compensation, this section shall
315prevail. The health plan selection criteria and scoring system,
316and the scoring results, shall be available upon request for
317inspection after the bids have been awarded.
318     11.  Establish disenrollment criteria in the event local
319matching funds are insufficient to cover enrollments.
320     12.  Develop and implement a plan to publicize the Florida
321Kidcare program Healthy Kids Corporation, the eligibility
322requirements of the program, and the procedures for enrollment
323in the program and to maintain public awareness of the
324corporation and the program. Health care and dental health plans
325participating in the program may develop and distribute
326marketing and other promotional materials and participate in
327activities, such as health fairs and public events, as approved
328by the corporation. Health care and dental health plans may also
329contact their current and former enrollees to encourage
330continued participation in the program and assist the enrollee
331in transferring from a Title XIX-funded plan to a Title XXI-
332funded plan.
333     13.  Establish an assignment process for Florida Healthy
334Kids program enrollees to ensure that family members are
335assigned to the same managed care plan to the greatest extent
336possible, including situations in which some family members are
337enrolled in a Medicaid managed care plan and other family
338members are enrolled in a Florida Healthy Kids plan. The Agency
339for Health Care Administration shall consult with the
340corporation to implement this subparagraph.
341     14.13.  Secure staff necessary to properly administer the
342corporation. Staff costs shall be funded from state and local
343matching funds and such other private or public funds as become
344available. The board of directors shall determine the number of
345staff members necessary to administer the corporation.
346     15.14.  Provide a report annually to the Governor, Chief
347Financial Officer, Commissioner of Education, Senate President,
348Speaker of the House of Representatives, and Minority Leaders of
349the Senate and the House of Representatives.
350     16.  Provide a report by October 31, 2008, to the Governor,
351the Senate, and the House of Representatives, which includes an
352actuarial analysis of the projected impact on premiums from the
353addition of habilitative and behavior analysis services in
354accordance with s. 409.815.
355     17.  Provide information on a quarterly basis to the
356Governor, the Senate, and the House of Representatives that
357assesses the cost and utilization of services for the Florida
358Healthy Kids health benefits plans provided through the Florida
359Healthy Kids Corporation. The information must be specific to
360each eligibility component of the plan and, at a minimum,
361include:
362     a.  The monthly enrollment and expenditures for enrollees.
363     b.  The cost and utilization of specific services.
364     c.  An analysis of the impact on premiums prior to and
365following implementation of the Window of Opportunity Act.
366     d.  An analysis of trends regarding transfer of enrollees
367from the Florida Healthy Kids plans to the Children's Medical
368Services Network plan.
369     e.  Any recommendations resulting from the analysis
370conducted under this subparagraph.
371     18.15.  Establish benefit packages which conform to the
372provisions of the Florida Kidcare program, as created in ss.
373409.810-409.820.
374     Section 13.  Section 624.916, Florida Statutes, is created
375to read:
376     624.916  Developmental disabilities compact.--
377     (1)  The Office of Insurance Regulation shall convene a
378workgroup by August 31, 2008, for the purpose of negotiating a
379compact that includes a binding agreement among the participants
380relating to insurance and access to services for persons with
381developmental disabilities as defined in s. 393.063, with the
382addition of autism spectrum disorder as defined in s.
383391.026(2)(r)1. The workgroup shall consist of the following:
384     (a)  Representatives of all health insurers licensed under
385this chapter.
386     (b)  Representatives of all health maintenance
387organizations licensed under part I of chapter 641.
388     (c)  Representatives of employers with self-insured health
389benefit plans.
390     (d)  Two designees of the Governor, one of whom must be a
391consumer advocate.
392     (e)  A designee of the President of the Senate.
393     (f)  A designee of the Speaker of the House of
394Representatives.
395     (2)  The Office of Insurance Regulation shall convene a
396consumer advisory workgroup for the purpose of providing a forum
397for comment on the compact negotiated in subsection (1). The
398office shall convene the workgroup prior to finalization of the
399compact.
400     (3)  The agreement shall include the following components:
401     (a)  A requirement that each signatory to the agreement
402increase coverage for behavior analysis and behavior assistant
403services as defined in s. 409.815(2)(r) and speech therapy,
404physical therapy, and occupational therapy when necessary due to
405the presence of a developmental disability as defined in s.
406393.063 or autism spectrum disorder as defined in s.
407391.026(2)(r)1.
408     (b)  Procedures for clear and specific notice to
409policyholders identifying the amount, scope, and conditions
410under which coverage is provided for behavior analysis and
411behavior assistant services as defined in s. 409.815(2)(r) and
412speech therapy, physical therapy, and occupational therapy when
413necessary due to the presence of a developmental disability as
414defined in s. 393.063 or autism spectrum disorder as defined in
415s. 391.026(2)(r)1.
416     (c)  Penalties for documented cases of denial of claims for
417medically necessary services due to the presence of a
418developmental disability as defined in s. 393.063 or autism
419spectrum disorder as defined in s. 391.026(2)(r)1.
420     (d)  Proposals for new product lines that may be offered in
421conjunction with traditional health insurance and provide a more
422appropriate means of spreading risk, financing costs, and
423accessing favorable prices.
424     (4)  Upon completion of the negotiations for the compact,
425the office shall report the results to the Governor, the
426President of the Senate, and the Speaker of the House of
427Representatives.
428     (5)  Beginning February 15, 2009, and continuing annually
429thereafter, the Office of Insurance Regulation shall provide a
430report to the Governor, the President of the Senate, and the
431Speaker of the House of Representatives regarding the
432implementation of the agreement negotiated under this section.
433The report shall include:
434     (a)  The signatories to the agreement.
435     (b)  An analysis of the coverage provided under the
436agreement in comparison to the coverage required under ss.
437627.6686 and 641.31098.
438     (c)  An analysis of the compliance with the agreement by
439the signatories, including documented cases of claims denied in
440violation of the agreement.
441     (6)  The Office of Insurance Regulation shall continue to
442monitor participation, compliance, and effectiveness of the
443agreement and report its findings at least annually.
444     Section 14.  Section 627.6686, Florida Statutes, is created
445to read:
446     627.6686  Coverage for individuals with developmental
447disabilities required; exception.--
448     (1)  As used in this section, the term:
449     (a)  "Autism spectrum disorder" means any of the following
450disorders as defined with most recent edition of the Diagnostic
451and Statistical Manual of Mental Disorders of the American
452Psychiatric Association:
453     1.  Autistic disorder;
454     2.  Asperger syndrome; or
455     3.  Pervasive developmental disorder not otherwise
456specified.
457     (b)  "Developmental disability" has the same meaning as
458provided in s. 393.063.
459     (c)  "Eligible individual" means an individual under 18
460years of age or an individual 18 years of age or older who is in
461high school who has been diagnosed as having a developmental
462disability at 8 years of age or younger.
463     (d)  "Health insurance plan" means a group health insurance
464policy or group health benefit plan offered by an insurer which
465includes the state group insurance program provided under s.
466110.123. The term does not include any health insurance plan
467offered in the individual market, any health insurance plan that
468is individually underwritten, or any health insurance plan
469provided to a small employer.
470     (e)  "Insurer" means an insurer providing health insurance
471coverage, which is licensed to engage in the business of
472insurance in this state and is subject to insurance regulation.
473     (2)  A health insurance plan issued or renewed on or after
474July 1, 2009, shall provide coverage to an eligible individual
475for:
476     (a)  Well-baby and well-child screening for diagnosing the
477presence of a developmental disability.
478     (b)  Treatment of a developmental disability through speech
479therapy, occupational therapy, physical therapy, and behavior
480analysis services. Behavior analysis services shall be provided
481by an individual certified pursuant to s. 393.17 or an
482individual licensed under chapter 490 or chapter 491.
483     (3)  The coverage required pursuant to subsection (2) is
484subject to the following requirements:
485     (a)  Coverage shall be limited to treatment that is
486prescribed by the insured's treating physician in accordance
487with a treatment plan.
488     (b)  Coverage for the services described in subsection (2)
489shall be limited to $36,000 annually and may not exceed $108,000
490in total lifetime benefits.
491     (c)  Coverage may not be denied on the basis that provided
492services are habilitative in nature.
493     (d)  Coverage may be subject to other general exclusions
494and limitations of the insurer's policy or plan, including, but
495not limited to, coordination of benefits, participating provider
496requirements, restrictions on services provided by family or
497household members, and utilization review of health care
498services, including the review of medical necessity, case
499management, and other managed care provisions.
500     (4)  The coverage required pursuant to subsection (2) may
501not be subject to dollar limits, deductibles, or coinsurance
502provisions that are less favorable to an insured than the dollar
503limits, deductibles, or coinsurance provisions that apply to
504physical illnesses that are generally covered under the health
505insurance plan, except as otherwise provided in subsection (3).
506     (5)  An insurer may not deny or refuse to issue coverage
507for medically necessary services, refuse to contract with, or
508refuse to renew or reissue or otherwise terminate or restrict
509coverage for an individual because the individual is diagnosed
510as having a developmental disability.
511     (6)  The treatment plan required pursuant to subsection (3)
512shall include all elements necessary for the health insurance
513plan to appropriately pay claims. These elements include, but
514are not limited to, a diagnosis, the proposed treatment by type,
515the frequency and duration of treatment, the anticipated
516outcomes stated as goals, the frequency with which the treatment
517plan will be updated, and the signature of the treating
518physician.
519     (7)  Beginning January 1, 2011, the maximum benefit under
520paragraph (3)(b) shall be adjusted annually on January 1 of each
521calendar year to reflect any change from the previous year in
522the medical component of the then current Consumer Price Index
523for all urban consumers, published by the Bureau of Labor
524Statistics of the United States Department of Labor.
525     (8)  This section may not be construed as limiting benefits
526and coverage otherwise available to an insured under a health
527insurance plan.
528     (9)  The Office of Insurance Regulation may not enforce
529this section against an insurer that is a signatory to the
530developmental disabilities compact established under s. 624.916.
531     Section 15.  Section 641.31098, Florida Statutes, is
532created to read:
533     641.31098  Coverage for individuals with developmental
534disabilities.--
535     (1)  As used in this section, the term:
536     (a)  "Autism spectrum disorder" means any of the following
537disorders as defined with most recent edition of the Diagnostic
538and Statistical Manual of Mental Disorders of the American
539Psychiatric Association:
540     1.  Autistic disorder;
541     2.  Asperger syndrome; or
542     3.  Pervasive developmental disorder not otherwise
543specified.
544     (b)  "Developmental disability" has the same meaning as
545provided in s. 393.063 .
546     (c)  "Eligible individual" means an individual under 18
547years of age or an individual 18 years of age or older who is in
548high school who has been diagnosed as having a developmental
549disability at 8 years of age or younger.
550     (d)  "Health maintenance contract" means a group health
551maintenance contract offered by a health maintenance
552organization. This term does not include a health maintenance
553contract offered in the individual market, a health maintenance
554contract that is individually underwritten, or a health
555maintenance contract provided to a small employer.
556     (2)  A health maintenance contract issued or renewed on or
557after July 1, 2009, shall provide coverage to an eligible
558individual for:
559     (a)  Well-baby and well-child screening for diagnosing the
560presence of a developmental disability.
561     (b)  Treatment of a developmental disability through speech
562therapy, occupational therapy, physical therapy, and behavior
563analysis services. Behavior analysis services shall be provided
564by an individual certified pursuant to s. 393.17 or an
565individual licensed under chapter 490 or chapter 491.
566     (3)  The coverage required pursuant to subsection (2) is
567subject to the following requirements:
568     (a)  Coverage shall be limited to treatment that is
569prescribed by the subscriber's treating physician in accordance
570with a treatment plan.
571     (b)  Coverage for the services described in subsection (2)
572shall be limited to $36,000 annually and may not exceed $108,000
573in total benefits.
574     (c)  Coverage may not be denied on the basis that provided
575services are habilitative in nature.
576     (d)  Coverage may be subject to general exclusions and
577limitations of the subscriber's contract, including, but not
578limited to, coordination of benefits, participating provider
579requirements, and utilization review of health care services,
580including the review of medical necessity, case management, and
581other managed care provisions.
582     (4)  The coverage required pursuant to subsection (2) may
583not be subject to dollar limits, deductibles, or coinsurance
584provisions that are less favorable to a subscriber than the
585dollar limits, deductibles, or coinsurance provisions that apply
586to physical illnesses that are generally covered under the
587subscriber's contract, except as otherwise provided in
588subsection (3).
589     (5)  A health maintenance organization may not deny or
590refuse to issue coverage for medically necessary services,
591refuse to contract with, or refuse to renew or reissue or
592otherwise terminate or restrict coverage for an individual
593solely because the individual is diagnosed as having a
594developmental disability.
595     (6)  The treatment plan required pursuant to subsection (3)
596shall include, but is not limited to, a diagnosis, the proposed
597treatment by type, the frequency and duration of treatment, the
598anticipated outcomes stated as goals, the frequency with which
599the treatment plan will be updated, and the signature of the
600treating physician.
601     (7)  Beginning January 1, 2011, the maximum benefit under
602paragraph (3)(b) shall be adjusted annually on January 1 of each
603calendar year to reflect any change from the previous year in
604the medical component of the then current Consumer Price Index
605for all urban consumers, published by the Bureau of Labor
606Statistics of the United States Department of Labor.
607     (8)  The Office of Insurance Regulation may not enforce
608this section against a health maintenance organization that is a
609signatory no later than July 1, 2009, to the developmental
610disabilities compact established under s. 624.916. The Office of
611Insurance Regulation shall enforce this section against a health
612maintenance organization that is a signatory to the compact
613established under s. 624.916 if the health maintenance
614organization has not complied with the terms of the compact for
615all health maintenance contracts by July 1, 2010.
616
617
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T I T L E  A M E N D M E N T
619     Remove line 1541
620premium; amending s. 409.811, F.S.; providing a definition of
621the term "autism spectrum disorder"; amending s. 409.815, F.S.;
622revising provisions


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