Florida Senate - 2008 CS for CS for CS for SB 2654
By the Committees on Health and Human Services Appropriations; Health Policy; Banking and Insurance; and Senators Geller, Ring, Bennett, Deutch, Villalobos, Rich, Fasano, Garcia, Wise, (Additional Introducers on Last Printed Page)
603-07353-08 20082654c3
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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 as defined in s. 627.6699(3).
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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, psychologist, or board certified behavioral
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analyst, and any other necessary medical care. Coverage provided
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under this section is limited to treatment that is prescribed by
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the insured's treating medical physician in accordance with a
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treatment plan. With regards to a health insurance plan, an
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insurer may not deny or refuse to issue coverage for, refuse to
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contract with, or refuse to renew or reissue or otherwise
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terminate or restrict coverage for an individual because the
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individual is diagnosed as having 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). 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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Atwater, Margolis, Crist, Joyner, Justice, Dockery, Dean, Dawson
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and Saunders
CODING: Words stricken are deletions; words underlined are additions.