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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 limitation; providing for annual adjustments of

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the maximum benefit limitation; amending s. 1004.55, F.S.;

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relocating the regional autism center at Florida State

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University from the Department of Communication Disorders

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to the College of Medicine; providing for application of

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the act; 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 Coverage for autism spectrum disorder required;

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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 through speech therapy, occupational

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therapy, physical therapy, applied behavior analysis, treatment

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by a psychiatrist or psychologist, and any other necessary

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medical care. Coverage provided under this section is limited to

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treatment that is prescribed by the insured's treating medical

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physician in accordance with a treatment plan. With regards to a

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health insurance plan, an insurer may not deny or refuse to issue

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

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reissue or otherwise terminate or restrict coverage for an

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individual because the individual is diagnosed as having autism

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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). The coverage required in subsection (2) may not be denied on

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the basis that provided services are habilitative in nature. The

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coverage may not be subject to any limits on the number of visits

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an insured may make to a service provider. However, the coverage

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required pursuant to subsection (2) may be subject to other

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general exclusions and limitations of the insurer's policy or

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plan, including, but not limited to, coordination of benefits,

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participating provider requirements, restrictions on services

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provided by family or household members, and utilization review

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of health care services, including the review of medical

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necessity, case management, and other managed 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 therapy, as defined in subsection (2), is subject to

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

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this maximum benefit shall be adjusted annually on January 1 of

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each calendar year to reflect any change from the previous year

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in the medical component of the then current Consumer Price

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Index, All Urban Consumers, as published by the United States

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Department of Labor's Bureau of Labor Statistics.

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     (6) This section may not be construed as limiting benefits

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and coverage otherwise available to an insured under a health

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insurance plan.

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     Section 3.  Paragraph (a) of subsection (1) of section

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1004.55, Florida Statutes, is amended to read:

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     1004.55  Regional autism centers.--

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     (1)  Seven regional autism centers are established to

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provide nonresidential resource and training services for persons

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of all ages and of all levels of intellectual functioning who

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have autism, as defined in s. 393.063; who have a pervasive

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developmental disorder that is not otherwise specified; who have

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an autistic-like disability; who have a dual sensory impairment;

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or who have a sensory impairment with other handicapping

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conditions. Each center shall be operationally and fiscally

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independent and shall provide services within its geographical

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region of the state. Service delivery shall be consistent for all

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centers. Each center shall coordinate services within and between

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state and local agencies and school districts but may not

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duplicate services provided by those agencies or school

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districts. The respective locations and service areas of the

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centers are:

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     (a) The College of Medicine Department of Communication

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Disorders at Florida State University, which serves Bay, Calhoun,

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Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson,

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Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla,

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Walton, and Washington Counties.

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     Section 4.  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.

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                     ADDITIONAL INTRODUCERS

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Dockery, Dean and Dawson