Chapter 371
2012 -- S 2560 SUBSTITUTE A AS
AMENDED
Enacted 06/21/12
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
It is enacted by the
General Assembly as follows:
SECTION 1. Sections 27-20.11-1, 27-20.11-3 and 27-20.11-7 of
the General Laws in
Chapter 27-20.11 entitled
"Autism Spectrum Disorders" are hereby amended to read as follows:
27-20.11-1.
Mandatory coverage for Autism spectrum disorders. --
(a) Every group
health insurance contract, or every group hospital or
medical expense insurance policy, plan, or
group policy delivered, issued for delivery, or renewed in
this state, by any health insurance
carrier, on or after January 1, 2012, shall provide coverage
for autism spectrum disorders;
provided, however, the provisions of this chapter shall not
apply to contracts, plans or group
policies subject to the Small Employer Health Insurance
Availability Act, chapter 50 of this title,
Medical Assistance, chapter 40-8, or subject to the Individual Health Insurance
Coverage Act,
chapter 18.5 of this title.
27-20.11-3.
Scope of coverage. -- (a) Benefits under this
section shall include coverage
for pharmaceuticals, applied behavior analysis,
physical therapy, speech therapy, psychology,
psychiatric and occupational therapy services for the treatment
of Autism spectrum disorders, as
defined in the most recent edition of the DSM. Provided,
however:
(1) Coverage for
physical therapy, speech therapy and occupational therapy and
psychology, psychiatry and pharmaceutical services shall be, to the extent such services
are a
covered benefit for other diseases and conditions under such
policy; and
(2) Applied behavior
analysis shall be limited to thirty-two thousand dollars ($32,000)
per person per year.
(b) Benefits under this
section shall continue until the covered individual reaches age
fifteen (15).
(c) The health care
benefits outlined in this chapter apply only to services delivered
within the State of
provide coverage for those benefits mandated by this chapter
outside of the State of
where it can be established through a pre-authorization
process that the required services are not
available in the State of
27-20.11-7.
Credentialing and contracting practices. -- Credentials.
-- (a) Any
individual providing or supervising applied behavior
analysis treatment under this section shall
be:
(1) Individually
licensed by the department of health as a healthcare provider/clinician
pursuant to chapter 42-35 or 42-35-1 et al. and nationally
certified as a Board Certified Behavior
Analyst (BCBA); and credentialed by the insurer; licensed applied behavior analyst; or a
licensed
applied behavior assistant analyst acting under supervision;
or
(2) Individually
nationally certified as a Board Certified Assistant Behavior Analyst
(BCaBA) supervised by a
Board Certified Behavior Analyst who is licensed Licensed by the
department of health as a psychologist, with
equivalent experience or a psychologist practicing
social worker or therapist; and credentialed by the insurer.
within their scope of practice.
(b) Nothing in this
chapter shall be construed to require a change in the credentialing or
contracting practices of health insurers for mental health or
substance abuse providers.
SECTION 2. This act shall take effect upon passage.
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LC01475/SUB A
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