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27th Legislature(2011-2012)

Bill Text 27th Legislature


00 Enrolled SB 74                                                                                                          
01 Requiring insurance coverage for autism spectrum disorders, describing the method for                                   
02 establishing a covered treatment plan for those disorders, and defining the covered treatment                           
03 for those disorders; establishing the Comprehensive Autism Early Diagnosis and Treatment                                
04 Task Force; and providing for an effective date.                                                                        
05                           _______________                                                                               
06    * Section 1. AS 21.42 is amended by adding a new section to read:                                                  
07            Sec. 21.42.397. Coverage for autism spectrum disorders. (a) Except for a                                   
08       fraternal benefit society, a health care insurer that offers, issues for delivery, delivers,                      
09       or renews a health care insurance plan in this state shall provide coverage for the costs                         
10       of the diagnosis and treatment of autism spectrum disorders. Coverage required by this                            
11       subsection must include treatment prescribed by a licensed physician, psychologist, or                            
12       advanced nurse practitioner, provided by or supervised by an autism service provider,                             
13       and as identified in a treatment plan developed following a comprehensive evaluation.                             
14       Covered treatment includes medically necessary pharmacy care, psychiatric care,                                   
01       psychological care, habilitative or rehabilitative care, and therapeutic care. In this                            
02       subsection,                                                                                                       
03                 (1)  "habilitative or rehabilitative care" means professional counseling,                               
04       guidance services, and treatment programs necessary to develop, restore, or maintain                              
05       the functioning of an individual to the maximum extent practicable, including applied                             
06       behavior analysis or other structured behavioral therapies; in this paragraph, "applied                           
07       behavior analysis" means the design, implementation, and evaluation of environmental                              
08       modifications, using behavioral stimuli and consequences, including direct                                        
09       observation, measurement, and functional analysis of the relationship between                                     
10       environment and behavior, to produce socially significant improvement in human                                    
11       behavior or to prevent the loss of an attained skill or function;                                                 
12                 (2)  "therapeutic care" means services provided by or under the                                         
13       supervision of a speech-language pathologist licensed under AS 08.11 or an                                        
14       occupational therapist or physical therapist licensed under AS 08.84.                                             
15            (b)  Coverage under this section                                                                             
16                 (1)  is required to be provided only to individuals under 21 years of                                   
17       age;                                                                                                              
18                 (2)  may not limit the number of visits to an autism service provider for                               
19       treatment;                                                                                                        
20                 (3)  is subject to copayment, deductible, and coinsurance provisions,                                   
21       and other general exclusions or limitations included in a health insurance policy to the                          
22       same extent as other health care services covered by the policy; and                                              
23                 (4)  must cover medically necessary treatment that is coordinated with                                  
24       an education program, but may not be contingent on the coordination of treatment                                  
25       with an education program.                                                                                        
26            (c)  An insurer providing health care insurance to a small employer in the                                   
27       group market with 20 or fewer employees is not required to provide insurance                                      
28       coverage to the small employer that includes the coverage required under (a) of this                              
29       section.                                                                                                          
30            (d)  The director may waive the coverage required in this section for an insurer                             
31       providing health care insurance to a small employer in the group market with 21 - 25                              
01       employees if the small employer demonstrates to the director by actual claims                                     
02       experience over any consecutive 12-month period that compliance with this section                                 
03       has increased the premium cost of the small employer's health insurance policy by                                 
04       three percent or more during the consecutive 12-month period.                                                     
05            (e)  This section does not limit benefits that are otherwise available to an                                 
06       individual under a health care insurance plan.                                                                    
07            (f)  A health care insurer may not refuse to deliver, execute, issue, amend, or                              
08       renew coverage to an individual or terminate coverage because the individual is                                   
09       diagnosed with or has received treatment for autism spectrum disorders.                                           
10            (g)  In this section,                                                                                        
11                 (1)  "autism service provider" means an individual who is licensed,                                     
12       certified, or registered by the applicable state licensing board or by a nationally                               
13       recognized certifying organization and who provides direct services to an individual                              
14       with an autism spectrum disorder;                                                                                 
15                 (2)  "autism spectrum disorders" means pervasive developmental                                          
16       disorders, or a group of conditions having substantially the same characteristics as                              
17       pervasive developmental disorders, as defined in the American Psychiatric                                         
18       Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR, as                                     
19       amended or reissued from time to time;                                                                            
20                 (3)  "health care insurance plan" has the meaning given in                                              
21       AS 21.54.500;                                                                                                     
22                 (4)  "health care insurer" has the meaning given in AS 21.54.500;                                       
23                 (5)  "medically necessary" means any care, treatment, intervention,                                     
24       service, or item prescribed by a licensed physician, psychologist, or advanced nurse                              
25       practitioner in accordance with accepted standards of practice that will, or is                                   
26       reasonably expected to,                                                                                           
27                      (A)  prevent the onset of an illness, condition, injury, or                                        
28            disability;                                                                                                  
29                      (B)  reduce or ameliorate the physical, mental, or developmental                                   
30            effects of an illness, condition, injury, or disability;                                                     
31                      (C)  assist to achieve or maintain maximum functional capacity                                     
01            in performing daily activities, taking into account both the functional capacity                             
02            of the individual and the functional capacity of other persons of the individual's                           
03            age.                                                                                                         
04    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
05 read:                                                                                                                   
06       AUTISM TASK FORCE. (a) The Comprehensive Autism Early Diagnosis and                                               
07 Treatment Task Force is created in the legislative branch for the purpose of making                                     
08 recommendations for the development of a statewide comprehensive plan to support early                                  
09 diagnosis and treatment of autism and studying the effects of the state's providing insurance                           
10 coverage for autism spectrum disorder.                                                                                  
11       (b)  The task force consists of nine members who, except for those in (1) and (2) of                              
12 this subsection, shall be appointed jointly by the President of the Senate and the Speaker of                           
13 the House of Representatives as follows:                                                                                
14            (1)  one senator selected by the President of the Senate, who shall serve as co-                             
15 chair;                                                                                                                  
16            (2)  one representative selected by the Speaker of the House of                                              
17 Representatives, who shall serve as co-chair;                                                                           
18            (3)  one member representing mental health service providers;                                                
19            (4)  one member from the Governor's Council on Disabilities and Special                                      
20 Education (AS 47.80.030);                                                                                               
21            (5)  the commissioner of health and social services or the commissioner's                                    
22 designee;                                                                                                               
23            (6)  the commissioner of administration or the commissioner's designee;                                      
24            (7)  the director of the division of insurance, Department of Commerce,                                      
25 Community, and Economic Development, or the director's designee;                                                        
26            (8)  one member representing a private insurance provider who offers health-                                 
27 insurance-related services in the state; and                                                                            
28            (9)  one parent or guardian of an autistic child.                                                            
29       (c)  The task force shall, not later than January 15, 2013, submit a report to the                                
30 legislature and the Governor. The report must include                                                                   
31            (1)  policy options to achieve a comprehensive autism spectrum disorder early                                
01 diagnosis and treatment program that results in coverage to the greatest number of residents in                         
02 the state;                                                                                                              
03            (2)  recommendations to the legislature and the Governor that include draft                                  
04 legislation required to achieve the policy options proposed by the task force;                                          
05            (3)  an evaluation of the fiscal effect of the policy options proposed by the task                           
06 force that includes a five-year projection of both public sector and private sector costs and                           
07 expenditures;                                                                                                           
08            (4)  an analysis of how the implementation of P.L. 111-148 (Patient Protection                               
09 and Affordable Care Act) is expected to affect the options, recommendations, and fiscal                                 
10 evaluations of the task force.                                                                                          
11       (d)  The task force shall meet as needed during the interim following the Second                                  
12 Regular Session in 2012.                                                                                                
13       (e)  The task force may request administrative and technical support from the                                     
14 Department of Education and Early Development.                                                                          
15       (f)  Members of the task force shall serve without compensation but are entitled to per                           
16 diem and travel expenses authorized for boards and commissions under AS 39.20.180.                                      
17       (g)  The task force terminates on January 15, 2013, unless extended.                                              
18    * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to                          
19 read:                                                                                                                   
20       APPLICABILITY. AS 21.42.397, enacted by sec. 1 of this Act, applies to a health                                   
21 insurance policy that is offered, issued for delivery, delivered, or renewed on or after                                
22 January 1, 2013.                                                                                                        
23    * Sec. 4. Section 2 of this Act takes effect immediately under AS 01.10.070(c).                                    
24    * Sec. 5. Except as provided in sec. 4 of this Act, this Act takes effect January 1, 2013.                         
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