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A bill to be entitled

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An act relating to autism spectrum disorder; providing a

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short title; creating s. 627.6686, F.S.; providing

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definitions; requiring health insurance plans to provide

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coverage for screening, diagnosis, intervention, and

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treatment of autism spectrum disorder in certain children;

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requiring a treatment plan; prohibiting an insurer from

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denying or refusing coverage or refusing to renew or

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reissue or terminate coverage based on a diagnosis of

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autism spectrum disorder; providing coverage limitations;

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providing treatment plan requirements; limiting the

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frequency of requests for updating a treatment plan;

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providing eligibility requirements; providing a maximum

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benefit that is adjusted annually; providing for

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application; providing an effective date.

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

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     Section 1. This act may be cited as the "Window of

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Opportunity Act."

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     Section 2.  Section 627.6686, Florida Statutes, is created

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to read:

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     627.6686 Optional coverage for autism spectrum disorder

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required; exception.--

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     (1) As used in this section, the term:

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     (a) "Applied behavior analysis" means the design,

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implementation, and evaluation of environmental modifications,

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using behavioral stimuli and consequences, to produce socially

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significant improvement in human behavior, including, but not

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limited to, the use of direct observation, measurement, and

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functional analysis of the relations between environment and

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behavior.

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     (b) "Autism spectrum disorder" means any of the following

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disorders as defined in the most recent edition of the Diagnostic

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and Statistical Manual of Mental Disorders of the American

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Psychiatric Association:

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     1. Autistic disorder.

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     2. Asperger's syndrome.

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     3. Pervasive developmental disorder not otherwise

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specified.

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     (c) "Health insurance plan" means a group health insurance

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policy or group health benefit plan offered by an insurer which

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includes the state group insurance program provided under s.

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110.123. The term does not include any health insurance plan

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offered in the individual market, any health insurance plan that

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is individually underwritten, or any health insurance plan

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provided to a small employer.

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     (d) "Insurer" means an insurer, health maintenance

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organization, or any other entity providing health insurance

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coverage which is licensed to engage in the business of insurance

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in this state and is subject to insurance regulation.

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     (2) A health insurance plan shall provide coverage for

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well-baby and well-child screening for diagnosing the presence of

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autism spectrum disorder and the intervention and treatment of

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autism spectrum disorder. Coverage provided under this section is

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limited to treatment that is prescribed by the insured's treating

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medical physician in accordance with a treatment plan. With

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regard to a health insurance plan, an insurer may not deny or

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refuse to issue coverage for, refuse to contract with, or refuse

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to renew or reissue or otherwise terminate or restrict coverage

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for an individual because the individual is diagnosed as having

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autism spectrum disorder.

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     (3) The coverage required pursuant to subsection (2) may

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not be subject to dollar limits, deductibles, or coinsurance

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provisions that are less favorable to an insured than the dollar

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limits, deductibles, or coinsurance provisions that apply to

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physical illnesses that are generally covered under the health

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insurance plan, except as otherwise provided for in subsection

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(5). However, the coverage required pursuant to subsection (2)

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may be subject to other general exclusions and limitations of the

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insurer's policy or plan, including, but not limited to,

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coordination of benefits, participating provider requirements,

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restrictions on services provided by family or household members,

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and utilization review of health care services, including the

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review of medical necessity, case management, and other managed

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care provisions.

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     (4) The treatment plan required pursuant to subsection (2)

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must include all elements necessary for the health insurance plan

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to appropriately pay claims. These elements include, but are not

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limited to, a diagnosis, the proposed treatment by type, the

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frequency and duration of treatment, the anticipated outcomes

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stated as goals, the frequency by which the treatment plan will

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be updated, and the treating medical doctor's signature. A health

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insurance plan may request an updated treatment plan only once

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every 6 months from the treating medical doctor for purposes of

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reviewing medical necessity unless the health insurance plan and

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the treating medical doctor agree that a more frequent review is

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necessary due to emerging clinical circumstances.

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     (5) To be eligible for benefits and coverage under this

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section, an individual must be diagnosed as having autistic

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spectrum disorder at 8 years of age or younger. The benefits and

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coverage provided pursuant to this section shall be provided to

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any eligible person younger than 18 years of age or to any

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eligible person 18 years of age or older who is in high school.

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Coverage for behavioral therapy is subject to a maximum benefit

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of $36,000 per year. Beginning January 1, 2010, this maximum

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benefit shall be adjusted annually on January 1 of each calendar

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year to reflect any change from the previous year in the medical

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component of the then-current Consumer Price Index, All Urban

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Consumers, as published by the United States Department of

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Labor's Bureau of Labor Statistics.

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     Section 3.  This act shall take effect January 1, 2009, and

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applies to health insurance policies or plans issued, renewed,

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entered into, or delivered on or after that date.