SB 250: "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 SENATE BILL NO. 250 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) "rehabilitative care" means professional counseling, guidance 03 services, and treatment programs, including applied behavior analysis necessary to 04 develop, restore, and maintain the functioning of an individual to the maximum extent 05 practicable; in this paragraph, "applied behavior analysis" means the design, 06 implementation, and evaluation of environmental modifications, using behavioral 07 stimuli and consequences, including direct observation, measurement, and functional 08 analysis of the relationship between environment and behavior, to produce socially 09 significant improvement in human behavior or to prevent the loss of an attained skill 10 or function; 11 (2) "therapeutic care" means services provided by or under the 12 supervision of a speech-language pathologist licensed under AS 08.11 or an 13 occupational therapist or physical therapist licensed under AS 08.84. 14 (b) Coverage under this section 15 (1) is required to be provided only to individuals under 21 years of 16 age; 17 (2) must provide a maximum benefit of $36,000 a year, adjusted 18 annually, beginning January 1, 2012, by the percentage change in the Consumer Price 19 Index for all urban consumers compiled by the United States Department of Labor, 20 Bureau of Labor Statistics; payments made by an insurer on behalf of a covered 21 individual for treatment of a medical condition unrelated to the individual's autism 22 spectrum disorder may not be applied toward the maximum benefit established in this 23 paragraph; 24 (3) may not limit the number of visits to an autism service provider for 25 treatment; 26 (4) is subject to copayment, deductible, and coinsurance provisions, 27 and other general exclusions or limitations included in a health insurance policy to the 28 same extent as other health care services covered by the policy; and 29 (5) must cover medically necessary treatment that is coordinated with 30 an education program, but may not be contingent on the coordination of treatment 31 with an education program.
01 (c) This section does not limit benefits that are otherwise available to an 02 individual under a health care insurance plan. 03 (d) A health care insurer may not terminate, refuse to deliver, execute, issue, 04 amend, or renew coverage to an individual because the individual is diagnosed with or 05 received treatment of autism spectrum disorders. 06 (e) In this section, 07 (1) "autism service provider" means an individual who provides direct 08 services to a person with autism spectrum disorder, is licensed, certified, or registered 09 by the applicable state licensing board or by a nationally recognized organization, and 10 who qualifies under one of the following: 11 (A) has received a doctoral degree with a specialty in 12 psychiatry, medicine, or clinical psychology, is actively licensed in the 13 specialty, and has one year of direct experience in behavioral therapies that are 14 consistent with best practice and research on effectiveness for people with 15 autism spectrum disorders; 16 (B) has received a doctoral degree in behavioral or health 17 sciences and has completed one year of experience in behavioral therapies that 18 are consistent with best practice and research on effectiveness for people with 19 autism spectrum disorders; 20 (C) has received a master's degree or higher in behavioral 21 sciences and is nationally certified as a board certified behavior analyst or 22 certified by a similar nationally recognized organization; 23 (D) has received a master's degree or higher in behavior or 24 health sciences, is licensed as a physical therapist, occupational therapist, or 25 speech-language pathologist, and has completed one year of directly 26 supervised experience in behavioral therapies for people with autism spectrum 27 disorders; 28 (E) has received a baccalaureate degree or higher in behavioral 29 sciences and is nationally certified as a board certified associate behavior 30 analyst or certified by a similar nationally recognized organization; 31 (2) "autism spectrum disorders" are those defined by the current
01 edition of the American Psychiatric Association's Diagnostic and Statistical Manual of 02 Mental Disorders, including autistic disorder, Asperger's disorder, and pervasive 03 developmental disorder not otherwise specified; 04 (3) "health care insurance plan" has the meaning given in 05 AS 21.54.500; 06 (4) "health care insurer" has the meaning given in AS 21.54.500; 07 (5) "medically necessary" means any care, treatment, intervention, 08 service, or item prescribed by a licensed physician or psychologist in accordance with 09 accepted standards of practice that will, or is reasonably expected to, 10 (A) prevent the onset of an illness, condition, injury, or 11 disability; 12 (B) reduce or ameliorate the physical, mental, or developmental 13 effects of an illness, condition, injury, or disability; 14 (C) assist in achieving or maintaining maximum functional 15 capacity in performing daily activities. 16 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 17 read: 18 APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health 19 insurance policy that is offered, issued for delivery, delivered, or renewed on or after 20 January 1, 2011. 21 * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).