2012 -- S 2560 SUBSTITUTE A AS AMENDED

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LC01475/SUB A

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

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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:

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

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

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

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

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

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

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

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

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

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chapter 18.5 of this title.

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

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

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

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

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

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

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

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

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per person per year.

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

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fifteen (15).

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

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

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

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

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

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

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

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be:

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

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

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

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applied behavior assistant analyst acting under supervision; or

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

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

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department of health as a psychologist, with equivalent experience or a psychologist practicing

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social worker or therapist; and credentialed by the insurer. within their scope of practice.

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

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

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     SECTION 2. This act shall take effect upon passage.

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LC01475/SUB A

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS

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

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

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

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      This act would take effect upon passage.

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LC01475/SUB A

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