CS for CS for CS for SB 2654 First Engrossed (ntc)
20082654e1
1
A bill to be entitled
2
An act relating to autism spectrum disorder; providing a
3
short title; creating s. 627.6686, F.S.; providing
4
definitions; requiring health insurance plans to provide
5
coverage for screening, diagnosis, intervention, and
6
treatment of autism spectrum disorder in certain children;
7
requiring a treatment plan; prohibiting an insurer from
8
denying or refusing coverage or refusing to renew or
9
reissue or terminate coverage based on a diagnosis of
10
autism spectrum disorder; providing coverage limitations;
11
providing treatment plan requirements; limiting the
12
frequency of requests for updating a treatment plan;
13
providing eligibility requirements; providing a maximum
14
benefit limitation; providing for annual adjustments of
15
the maximum benefit limitation; amending s. 1004.55, F.S.;
16
relocating the regional autism center at Florida State
17
University from the Department of Communication Disorders
18
to the College of Medicine; providing for application of
19
the act; providing an effective date.
20
21
Be It Enacted by the Legislature of the State of Florida:
22
23
Section 1. This act may be cited as the "Steven A.
24
Geller Autism Coverage Act."
25
Section 2. Section 627.6686, Florida Statutes, is created
26
to read:
27
627.6686 Coverage for autism spectrum disorder required;
28
exception.--
29
(1) As used in this section, the term:
30
(a) "Applied behavior analysis" means the design,
31
implementation, and evaluation of environmental modifications,
32
using behavioral stimuli and consequences, to produce socially
33
significant improvement in human behavior, including, but not
34
limited to, the use of direct observation, measurement, and
35
functional analysis of the relations between environment and
36
behavior.
37
(b) "Autism spectrum disorder" means any of the following
38
disorders as defined in the most recent edition of the Diagnostic
39
and Statistical Manual of Mental Disorders of the American
40
Psychiatric Association:
41
1. Autistic disorder.
42
2. Asperger's syndrome.
43
3. Pervasive developmental disorder not otherwise
44
specified.
45
(c) "Health insurance plan" means a group health insurance
46
policy or group health benefit plan offered by an insurer which
47
includes the state group insurance program provided under s.
48
110.123. The term does not include any health insurance plan
49
offered in the individual market, any health insurance plan that
50
is individually underwritten, or any health insurance plan
51
provided to a small employer as defined in s. 627.6699(3).
52
(d) "Insurer" means an insurer, health maintenance
53
organization, or any other entity providing health insurance
54
coverage which is licensed to engage in the business of insurance
55
in this state and is subject to insurance regulation.
56
(2) A health insurance plan shall provide coverage for
57
well-baby and well-child screening for diagnosing the presence of
58
autism spectrum disorder and the intervention and treatment of
59
autism spectrum disorder through speech therapy, occupational
60
therapy, physical therapy, applied behavior analysis, treatment
61
by a psychiatrist, psychologist, or board certified behavior
62
analyst, and any other necessary medical care. Coverage provided
63
under this section is limited to treatment that is prescribed by
64
the insured's treating medical physician in accordance with a
65
treatment plan. With regards to a health insurance plan, an
66
insurer may not deny or refuse to issue coverage for, refuse to
67
contract with, or refuse to renew or reissue or otherwise
68
terminate or restrict coverage for an individual because the
69
individual is diagnosed as having autism spectrum disorder.
70
(3) The coverage required pursuant to subsection (2) may
71
not be subject to dollar limits, deductibles, or coinsurance
72
provisions that are less favorable to an insured than the dollar
73
limits, deductibles, or coinsurance provisions that apply to
74
physical illnesses that are generally covered under the health
75
insurance plan, except as otherwise provided for in subsection
76
(5). The coverage required in subsection (2) may not be denied on
77
the basis that provided services are habilitative in nature. The
78
coverage may not be subject to any limits on the number of visits
79
an insured may make to a service provider. However, the coverage
80
required pursuant to subsection (2) may be subject to other
81
general exclusions and limitations of the insurer's policy or
82
plan, including, but not limited to, coordination of benefits,
83
participating provider requirements, restrictions on services
84
provided by family or household members, and utilization review
85
of health care services, including the review of medical
86
necessity, case management, and other managed care provisions.
87
(4) The treatment plan required pursuant to subsection (2)
88
must include all elements necessary for the health insurance plan
89
to appropriately pay claims. These elements include, but are not
90
limited to, a diagnosis, the proposed treatment by type, the
91
frequency and duration of treatment, the anticipated outcomes
92
stated as goals, the frequency by which the treatment plan will
93
be updated, and the treating medical doctor's signature. A health
94
insurance plan may request an updated treatment plan only once
95
every 6 months from the treating medical doctor for purposes of
96
reviewing medical necessity unless the health insurance plan and
97
the treating medical doctor agree that a more frequent review is
98
necessary due to emerging clinical circumstances.
99
(5) To be eligible for benefits and coverage under this
100
section, an individual must be diagnosed as having autistic
101
spectrum disorder at 8 years of age or younger. The benefits and
102
coverage provided pursuant to this section shall be provided to
103
any eligible person younger than 18 years of age or to any
104
eligible person 18 years of age or older who is in high school.
105
Coverage for therapy, as defined in subsection (2), is subject to
106
a maximum benefit of $36,000 per year. Beginning January 1, 2010,
107
this maximum benefit shall be adjusted annually on January 1 of
108
each calendar year to reflect any change from the previous year
109
in the medical component of the then current Consumer Price
110
Index, All Urban Consumers, as published by the United States
111
Department of Labor's Bureau of Labor Statistics.
112
(6) This section may not be construed as limiting benefits
113
and coverage otherwise available to an insured under a health
114
insurance plan.
115
Section 3. Paragraph (a) of subsection (1) of section
116
1004.55, Florida Statutes, is amended to read:
117
1004.55 Regional autism centers.--
118
(1) Seven regional autism centers are established to
119
provide nonresidential resource and training services for persons
120
of all ages and of all levels of intellectual functioning who
121
have autism, as defined in s. 393.063; who have a pervasive
122
developmental disorder that is not otherwise specified; who have
123
an autistic-like disability; who have a dual sensory impairment;
124
or who have a sensory impairment with other handicapping
125
conditions. Each center shall be operationally and fiscally
126
independent and shall provide services within its geographical
127
region of the state. Service delivery shall be consistent for all
128
centers. Each center shall coordinate services within and between
129
state and local agencies and school districts but may not
130
duplicate services provided by those agencies or school
131
districts. The respective locations and service areas of the
132
centers are:
133
(a) The College of Medicine Department of Communication
134
Disorders at Florida State University, which serves Bay, Calhoun,
135
Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson,
136
Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla,
137
Walton, and Washington Counties.
138
Section 4. This act shall take effect January 1, 2009, and
139
applies to health insurance policies or plans issued, renewed,
140
entered into, or delivered on or after that date.
CODING: Words stricken are deletions; words underlined are additions.