2012 -- S 2560 SUBSTITUTE A

=======

LC01475/SUB A

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

____________

A N A C T

RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS

     Introduced By: Senators E O`Neill, Perry, Gallo, Ottiano, and Goodwin

     Date Introduced: February 28, 2012

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. Sections 27-20.11-1, 27-20.11-3 and 27-20.11-7 of the General Laws in

1-2

Chapter 27-20.11 entitled "Autism Spectrum Disorders" are hereby amended to read as follows:

1-3

     27-20.11-1. Mandatory coverage for Autism spectrum disorders. -- (a) Every group

1-4

health insurance contract, or every group hospital or medical expense insurance policy, plan, or

1-5

group policy delivered, issued for delivery, or renewed in this state, by any health insurance

1-6

carrier, on or after January 1, 2012, shall provide coverage for autism spectrum disorders;

1-7

provided, however, the provisions of this chapter shall not apply to contracts, plans or group

1-8

policies subject to the Small Employer Health Insurance Availability Act, chapter 50 of this title,

1-9

Medical Assistance, chapter 40-8, or subject to the Individual Health Insurance Coverage Act,

1-10

chapter 18.5 of this title.

1-11

     27-20.11-3. Scope of coverage. -- (a) Benefits under this section shall include coverage

1-12

for pharmaceuticals, applied behavior analysis, physical therapy, speech therapy, psychology,

1-13

psychiatric and occupational therapy services for the treatment of Autism spectrum disorders, as

1-14

defined in the most recent edition of the DSM. Provided, however:

1-15

     (1) Coverage for physical therapy, speech therapy and occupational therapy and

1-16

psychology, psychiatry and pharmaceutical services shall be, to the extent such services are a

1-17

covered benefit for other diseases and conditions under such policy; and

1-18

     (2) Applied behavior analysis shall be limited to thirty-two thousand dollars ($32,000)

1-19

per person per year.

2-20

     (b) Benefits under this section shall continue until the covered individual reaches age

2-21

fifteen (15).

2-22

     (c) The health care benefits outlined in this chapter apply only to services delivered

2-23

within the State of Rhode Island; provided, that all health insurance carriers shall be required to

2-24

provide coverage for those benefits mandated by this chapter outside of the State of Rhode Island

2-25

where it can be established through a pre-authorization process that the required services are not

2-26

available in the State of Rhode Island from a provider in the health insurance carrier's network.

2-27

     27-20.11-7. Credentialing and contracting practices. -- Credentials. -- (a) Any

2-28

individual providing or supervising applied behavior analysis treatment under this section shall

2-29

be:

2-30

      (1) Individually licensed by the department of health as a healthcare provider/clinician

2-31

pursuant to chapter 42-35 or 42-35-1 et al. and nationally certified as a Board Certified Behavior

2-32

Analyst (BCBA); and credentialed by the insurer; licensed applied behavior analyst; or a licensed

2-33

applied behavior assistant analyst acting under supervision; or

2-34

      (2) Individually nationally certified as a Board Certified Assistant Behavior Analyst

2-35

(BCaBA) supervised by a Board Certified Behavior Analyst who is licensed Licensed by the

2-36

department of health as a psychologist, with equivalent experience social worker or therapist; and

2-37

credentialed by the insurer. within their scope of practice.

2-38

      (b) Nothing in this chapter shall be construed to require a change in the credentialing or

2-39

contracting practices of health insurers for mental health or substance abuse providers.

2-40

     SECTION 2. This act shall take effect upon passage.

=======

LC01475/SUB A

========

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS

***

3-1

     This act would mandate that insurance for Autism spectrum disorders include coverage

3-2

for pharmaceuticals and for psychological and psychiatric services. This act would also require

3-3

individuals providing behavior analysis treatment be licensed by the department of health.

3-4

      This act would take effect upon passage.

=======

LC01475/SUB A

=======