Chapter 397

2012 -- H 7165 SUBSTITUTE A

Enacted 06/21/12





     Introduced By: Representatives Palumbo, Morrison, Corvese, Naughton, and E Coderre

     Date Introduced: January 18, 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 Rhode Island; provided, that all health insurance carriers shall be required to

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

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

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


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

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


      (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.



LC00681/SUB A/2