HB 187: "An Act requiring insurance coverage for autism spectrum disorders, describing the method for establishing a treatment plan for those disorders, and defining the treatment required for those disorders; and providing for an effective date."
00 HOUSE BILL NO. 187 01 "An Act requiring insurance coverage for autism spectrum disorders, describing the 02 method for establishing a treatment plan for those disorders, and defining the treatment 03 required for those disorders; and providing for an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 21.42 is amended by adding a new section to read: 06 Sec. 21.42.397. Coverage for autism spectrum disorders. (a) Except for a 07 fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, 08 or renews a health care insurance plan in this state shall provide coverage for the costs 09 of the diagnosis and treatment of autism spectrum disorders. Coverage for the cost of 10 treatment required by this subsection must cover the treatment of the disorders 11 prescribed by a licensed physician or psychologist and provided by an autism service 12 provider as identified in a treatment plan developed following a comprehensive 13 evaluation. A treatment plan developed under this subsection must identify the 14 medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative
01 care, and therapeutic care required. In this subsection, 02 (1) "medically necessary" means any care, treatment, intervention, 03 service, or item prescribed by a licensed physician or psychologist in accordance with 04 accepted standards of practice that will, or is reasonably expected to, 05 (A) prevent the onset of an illness, condition, injury, or 06 disability; 07 (B) reduce or ameliorate the physical, mental, or developmental 08 effects of an illness, condition, injury, or disability; 09 (C) assist in achieving or maintaining maximum functional 10 capacity in performing daily activities; 11 (2) "rehabilitative care" means professional counseling, guidance 12 services, and treatment programs, including applied behavior analysis necessary to 13 develop, restore, and maintain the functioning of an individual to the maximum extent 14 practicable; in this paragraph, "applied behavior analysis" means the design, 15 implementation, and evaluation of environmental modifications, using behavioral 16 stimuli and consequences, including direct observation, measurement, and functional 17 analysis of the relationship between environment and behavior, to produce socially 18 significant improvement in human behavior or to prevent the loss of an attained skill 19 or function; 20 (3) "therapeutic care" means services provided by or under the 21 supervision of a speech-language pathologist licensed under AS 08.11 or an 22 occupational therapist or physical therapist licensed under AS 08.84. 23 (b) Coverage under this section 24 (1) is required to be provided only to individuals under 21 years of 25 age; 26 (2) must provide a maximum benefit of $36,000 a year, adjusted 27 annually, beginning January 1, 2011, by the percentage change in the Consumer Price 28 Index for all urban consumers compiled by the United States Department of Labor, 29 Bureau of Labor Statistics; payments made by an insurer on behalf of a covered 30 individual for treatment of a medical condition unrelated to the individual's autism 31 spectrum disorder may not be applied toward the maximum benefit established in this
01 paragraph; 02 (3) may not limit the number of visits to an autism service provider for 03 treatment; 04 (4) is subject to copayment, deductible, and coinsurance provisions, 05 and other general exclusions or limitations included in a health insurance policy to the 06 same extent as other health care services covered by the policy; and 07 (5) must cover treatment that is coordinated with an education 08 program, but may not be contingent on the coordination of treatment with an 09 education program. 10 (c) This section does not limit benefits that are otherwise available to an 11 individual under a health care insurance plan. 12 (d) A health care insurer may not terminate, refuse to deliver, execute, issue, 13 amend, or renew coverage to an individual because the individual is diagnosed with or 14 received treatment of autism spectrum disorders. 15 (e) In this section, 16 (1) "autism service provider" means a person, entity, or group 17 providing treatment of autism spectrum disorders; 18 (2) "autism spectrum disorders" are those defined by the current 19 edition of the American Psychiatric Association's Diagnostic and Statistical Manual of 20 Mental Disorders, including autistic disorder, Asperger's disorder, and pervasive 21 developmental disorder not otherwise specified; 22 (3) "health care insurance plan" has the meaning given in 23 AS 21.54.500; 24 (4) "health care insurer" has the meaning given in AS 21.54.500. 25 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 26 read: 27 APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health 28 insurance policy that is offered, issued for delivery, delivered, or renewed on or after 29 January 1, 2010. 30 * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).