2010 -- H 7260 | |
======= | |
LC00106 | |
======= | |
STATE OF RHODE ISLAND | |
| |
IN GENERAL ASSEMBLY | |
| |
JANUARY SESSION, A.D. 2010 | |
| |
____________ | |
| |
A N A C T | |
RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS | |
|
      |
|
      |
     Introduced By: Representatives Palumbo, Naughton, Corvese, Jackson, and D Caprio | |
     Date Introduced: January 28, 2010 | |
     Referred To: House Corporations | |
It is enacted by the General Assembly as follows: | |
1-1 |
     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness |
1-2 |
Insurance Policies" is hereby amended by adding thereto the following section: |
1-3 |
     27-18-71. Mandatory coverage for diagnosis and treatment of autism spectrum |
1-4 |
disorders. – (a) As used in this section: |
1-5 |
     (1) "Applied behavior analysis" means the design, implementation and evaluation of |
1-6 |
environmental modifications, using behavioral stimuli and consequences, to produce socially |
1-7 |
significant improvement in human behavior, including the use of direct observation, |
1-8 |
measurement, and functional analysis of the relationship between environment and behavior. |
1-9 |
     (2) "Autism services provider" means any person, entity, or group that provides treatment |
1-10 |
of autism spectrum disorders. |
1-11 |
     (3) "Autism spectrum disorders" means any of the pervasive developmental disorders as |
1-12 |
defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders |
1-13 |
(DSM), including Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Not |
1-14 |
Otherwise Specified. |
1-15 |
     (4) "Diagnosis of autism spectrum disorders" means medically necessary assessment, |
1-16 |
evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders. |
1-17 |
     (5) "Habilitative or rehabilitative care" means professional counseling, and guidance |
1-18 |
services and treatment programs, including applied behavioral analysis, that are necessary to |
1-19 |
develop, maintain, and restore, to the maximum extent practicable, the functioning of an |
2-1 |
individual. |
2-2 |
     (6) "Health insurance policy" means any group health policy or contract issued by an |
2-3 |
insurance entity subject to chapters 18, 19, 20 and 41 of title 27 of the general laws. |
2-4 |
     (7) "Medically necessary" means reasonably expected to do the following: |
2-5 |
     (i) Prevent the onset of an illness, condition, injury or disability; |
2-6 |
     (ii) Reduce or ameliorate the physical, mental or developmental effects of an illness, |
2-7 |
condition, injury or disability; or |
2-8 |
     (iii) Assist to achieve or maintain maximum functional capacity in performing daily |
2-9 |
activities, taking into account both the functional capacity of the individual and the functional |
2-10 |
capacities that are appropriate for individuals of the same age. |
2-11 |
     (8) "Pharmacy care" means medications prescribed by a licensed physician and any |
2-12 |
health-related services deemed medically necessary to determine the need or effectiveness of the |
2-13 |
medications. |
2-14 |
     (9) "Psychiatric care" means direct or consultative services provided by a psychiatrist |
2-15 |
licensed in the state in which the psychiatrist practices. |
2-16 |
     (10) "Psychological care" means direct or consultative services provided by a |
2-17 |
psychologist licensed in the state in which the psychologist practices. |
2-18 |
     (11) "Therapeutic care" means services provided by licensed or certified speech |
2-19 |
therapists, occupational therapists, or physical therapists. |
2-20 |
     (12) "Treatment for autism spectrum disorders" will include the following care |
2-21 |
prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum |
2-22 |
disorders by a licensed physician or a licensed psychologist who determines the care to be |
2-23 |
medically necessary: |
2-24 |
     (i) Habilitative or rehabilitative care; |
2-25 |
     (ii) Pharmacy care; |
2-26 |
     (iii) Psychiatric care; |
2-27 |
     (iv) Psychological care; and |
2-28 |
     (v) Therapeutic care. |
2-29 |
     (b)(1) Every individual or group health insurance contract, plan, or policy delivered, |
2-30 |
issued for delivery or renewed in this state shall provide coverage for the diagnosis and treatment |
2-31 |
of autism spectrum disorders. No insurer shall terminate coverage, or refuse to deliver, execute, |
2-32 |
issue, mend, adjust, or renew coverage to an individual solely because the individual is diagnosed |
2-33 |
with one of the autism spectrum disorders or has received treatment for autism spectrum |
2-34 |
disorders. |
3-1 |
     (2) The coverage required under this section shall not be subject to dollar limits, |
3-2 |
deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, |
3-3 |
deductibles, or coinsurance provisions that apply to physical illness generally under the health |
3-4 |
insurance policy. |
3-5 |
     (3) Coverage under this section shall not be subject to any limits on the number of visits |
3-6 |
an individual may make to an autism services provider. |
3-7 |
     (4) This section shall not be construed as limiting benefits that are otherwise available to |
3-8 |
an individual under a health insurance policy. |
3-9 |
     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service |
3-10 |
Corporations" is hereby amended by adding thereto the following section: |
3-11 |
     27-19-62. Mandatory coverage for diagnosis and treatment of autism spectrum |
3-12 |
disorders. – (a) As used in this section: |
3-13 |
     (1) "Applied behavior analysis" means the design, implementation and evaluation of |
3-14 |
environmental modifications, using behavioral stimuli and consequences, to produce socially |
3-15 |
significant improvement in human behavior, including the use of direct observation, |
3-16 |
measurement, and functional analysis of the relationship between environment and behavior. |
3-17 |
     (2) "Autism services provider" means any person, entity, or group that provides treatment |
3-18 |
of autism spectrum disorders. |
3-19 |
     (3) "Autism spectrum disorders" means any of the pervasive developmental disorders as |
3-20 |
defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders |
3-21 |
(DSM), including Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Not |
3-22 |
Otherwise Specified. |
3-23 |
     (4) "Diagnosis of autism spectrum disorders" means medically necessary assessment, |
3-24 |
evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders. |
3-25 |
     (5) "Habilitative or rehabilitative care" means professional counseling, and guidance |
3-26 |
services and treatment programs, including applied behavioral analysis, that are necessary to |
3-27 |
develop, maintain, and restore, to the maximum extent practicable, the functioning of an |
3-28 |
individual. |
3-29 |
     (6) "Health insurance policy" means any group health policy or contract issued by an |
3-30 |
insurance entity subject to chapters 18, 19, 20 and 41 of title 27 of the general laws. |
3-31 |
     (7) "Medically necessary" means reasonably expected to do the following: |
3-32 |
     (i) Prevent the onset of an illness, condition, injury or disability; |
3-33 |
     (ii) Reduce or ameliorate the physical, mental or developmental effects of an illness, |
3-34 |
condition, injury or disability; or |
4-1 |
     (iii) Assist to achieve or maintain maximum functional capacity in performing daily |
4-2 |
activities, taking into account both the functional capacity of the individual and the functional |
4-3 |
capacities that are appropriate for individuals of the same age. |
4-4 |
     (8) "Pharmacy care" means medications prescribed by a licensed physician and any |
4-5 |
health-related services deemed medically necessary to determine the need or effectiveness of the |
4-6 |
medications. |
4-7 |
     (9) "Psychiatric care" means direct or consultative services provided by a psychiatrist |
4-8 |
licensed in the state in which the psychiatrist practices. |
4-9 |
     (10) "Psychological care" means direct or consultative services provided by a |
4-10 |
psychologist licensed in the state in which the psychologist practices. |
4-11 |
     (11) "Therapeutic care" means services provided by licensed or certified speech |
4-12 |
therapists, occupational therapists, or physical therapists. |
4-13 |
     (12) "Treatment for autism spectrum disorders" will include the following care |
4-14 |
prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum |
4-15 |
disorders by a licensed physician or a licensed psychologist who determines the care to be |
4-16 |
medically necessary: |
4-17 |
     (i) Habilitative or rehabilitative care; |
4-18 |
     (ii) Pharmacy care; |
4-19 |
     (iii) Psychiatric care; |
4-20 |
     (iv) Psychological care; and |
4-21 |
     (v) Therapeutic care. |
4-22 |
     (b)(1) Every individual or group health insurance contract, plan, or policy, including any |
4-23 |
nonprofit hospital service contract plan or policy delivered, issued for delivery or renewed in this |
4-24 |
state shall provide coverage for the diagnosis and treatment of autism spectrum disorders. No |
4-25 |
insurer shall terminate coverage, or refuse to deliver, execute, issue, mend, adjust, or renew |
4-26 |
coverage to an individual solely because the individual is diagnosed with one of the autism |
4-27 |
spectrum disorders or has received treatment for autism spectrum disorders. |
4-28 |
     (2) The coverage required under this section shall not be subject to dollar limits, |
4-29 |
deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, |
4-30 |
deductibles, or coinsurance provisions that apply to physical illness generally under the health |
4-31 |
insurance policy. |
4-32 |
     (3) Coverage under this section shall not be subject to any limits on the number of visits |
4-33 |
an individual may make to an autism services provider. |
4-34 |
     (4) This section shall not be construed as limiting benefits that are otherwise available to |
5-1 |
an individual under a health insurance policy. |
5-2 |
     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service |
5-3 |
Corporations" is hereby amended by adding thereto the following sections: |
5-4 |
     27-20-57. Mandatory coverage for diagnosis and treatment of autism spectrum |
5-5 |
disorders. – (a) As used in this section: |
5-6 |
     (1) "Applied behavior analysis" means the design, implementation and evaluation of |
5-7 |
environmental modifications, using behavioral stimuli and consequences, to produce socially |
5-8 |
significant improvement in human behavior, including the use of direct observation, |
5-9 |
measurement, and functional analysis of the relationship between environment and behavior. |
5-10 |
     (2) "Autism services provider" means any person, entity, or group that provides treatment |
5-11 |
of autism spectrum disorders. |
5-12 |
     (3) "Autism spectrum disorders" means any of the pervasive developmental disorders as |
5-13 |
defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders |
5-14 |
(DSM), including Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Not |
5-15 |
Otherwise Specified. |
5-16 |
     (4) "Diagnosis of autism spectrum disorders" means medically necessary assessment, |
5-17 |
evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders. |
5-18 |
     (5) "Habilitative or rehabilitative care" means professional counseling, and guidance |
5-19 |
services and treatment programs, including applied behavioral analysis, that are necessary to |
5-20 |
develop, maintain, and restore, to the maximum extent practicable, the functioning of an |
5-21 |
individual. |
5-22 |
     (6) "Health insurance policy" means any group health policy or contract issued by an |
5-23 |
insurance entity subject to chapters 18, 19, 20 and 41 of title 27 of the general laws. |
5-24 |
     (7) "Medically necessary" means reasonably expected to do the following: |
5-25 |
     (i) Prevent the onset of an illness, condition, injury or disability; |
5-26 |
     (ii) Reduce or ameliorate the physical, mental or developmental effects of an illness, |
5-27 |
condition, injury or disability; or |
5-28 |
     (iii) Assist to achieve or maintain maximum functional capacity in performing daily |
5-29 |
activities, taking into account both the functional capacity of the individual and the functional |
5-30 |
capacities that are appropriate for individuals of the same age. |
5-31 |
     (8) "Pharmacy care" means medications prescribed by a licensed physician and any |
5-32 |
health-related services deemed medically necessary to determine the need or effectiveness of the |
5-33 |
medications. |
5-34 |
     (9) "Psychiatric care" means direct or consultative services provided by a psychiatrist |
6-1 |
licensed in the state in which the psychiatrist practices. |
6-2 |
     (10) "Psychological care" means direct or consultative services provided by a |
6-3 |
psychologist licensed in the state in which the psychologist practices. |
6-4 |
     (11) "Therapeutic care" means services provided by licensed or certified speech |
6-5 |
therapists, occupational therapists, or physical therapists. |
6-6 |
     (12) "Treatment for autism spectrum disorders" will include the following care |
6-7 |
prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum |
6-8 |
disorders by a licensed physician or a licensed psychologist who determines the care to be |
6-9 |
medically necessary: |
6-10 |
     (i) Habilitative or rehabilitative care; |
6-11 |
     (ii) Pharmacy care; |
6-12 |
     (iii) Psychiatric care; |
6-13 |
     (iv) Psychological care; and |
6-14 |
     (v) Therapeutic care. |
6-15 |
     (b)(1) Any nonprofit medical service contract, plan, or policy delivered, issued for |
6-16 |
delivery or renewed in this state shall provide coverage for the diagnosis and treatment of autism |
6-17 |
spectrum disorders. No insurer shall terminate coverage, or refuse to deliver, execute, issue, |
6-18 |
mend, adjust, or renew coverage to an individual solely because the individual is diagnosed with |
6-19 |
one of the autism spectrum disorders or has received treatment for autism spectrum disorders. |
6-20 |
     (2) The coverage required under this section shall not be subject to dollar limits, |
6-21 |
deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, |
6-22 |
deductibles, or coinsurance provisions that apply to physical illness generally under the health |
6-23 |
insurance policy. |
6-24 |
     (3) Coverage under this section shall not be subject to any limits on the number of visits |
6-25 |
an individual may make to an autism services provider. |
6-26 |
     (4) This section shall not be construed as limiting benefits that are otherwise available to |
6-27 |
an individual under a health insurance policy. |
6-28 |
     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance |
6-29 |
Organizations" is hereby amended by adding thereto the following section: |
6-30 |
     27-41-75. Mandatory coverage for diagnosis and treatment of autism spectrum |
6-31 |
disorders. – (a) As used in this section: |
6-32 |
     (1) "Applied behavior analysis" means the design, implementation and evaluation of |
6-33 |
environmental modifications, using behavioral stimuli and consequences, to produce socially |
6-34 |
significant improvement in human behavior, including the use of direct observation, |
7-1 |
measurement, and functional analysis of the relationship between environment and behavior. |
7-2 |
     (2) "Autism services provider" means any person, entity, or group that provides treatment |
7-3 |
of autism spectrum disorders. |
7-4 |
     (3) "Autism spectrum disorders" means any of the pervasive developmental disorders as |
7-5 |
defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders |
7-6 |
(DSM), including Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Not |
7-7 |
Otherwise Specified. |
7-8 |
     (4) "Diagnosis of autism spectrum disorders" means medically necessary assessment, |
7-9 |
evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders. |
7-10 |
     (5) "Habilitative or rehabilitative care" means professional counseling, and guidance |
7-11 |
services and treatment programs, including applied behavioral analysis, that are necessary to |
7-12 |
develop, maintain, and restore, to the maximum extent practicable, the functioning of an |
7-13 |
individual. |
7-14 |
     (6) "Health insurance policy" means any group health policy or contract issued by an |
7-15 |
insurance entity subject to chapters 18, 19, 20 and 41 of title 27 of the general laws. |
7-16 |
     (7) "Medically necessary" means reasonably expected to do the following: |
7-17 |
     (i) Prevent the onset of an illness, condition, injury or disability; |
7-18 |
     (ii) Reduce or ameliorate the physical, mental or developmental effects of an illness, |
7-19 |
condition, injury or disability; or |
7-20 |
     (iii) Assist to achieve or maintain maximum functional capacity in performing daily |
7-21 |
activities, taking into account both the functional capacity of the individual and the functional |
7-22 |
capacities that are appropriate for individuals of the same age. |
7-23 |
     (8) "Pharmacy care" means medications prescribed by a licensed physician and any |
7-24 |
health-related services deemed medically necessary to determine the need or effectiveness of the |
7-25 |
medications. |
7-26 |
     (9) "Psychiatric care" means direct or consultative services provided by a psychiatrist |
7-27 |
licensed in the state in which the psychiatrist practices. |
7-28 |
     (10) "Psychological care" means direct or consultative services provided by a |
7-29 |
psychologist licensed in the state in which the psychologist practices. |
7-30 |
     (11) "Therapeutic care" means services provided by licensed or certified speech |
7-31 |
therapists, occupational therapists, or physical therapists. |
7-32 |
     (12) "Treatment for autism spectrum disorders" will include the following care |
7-33 |
prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum |
7-34 |
disorders by a licensed physician or a licensed psychologist who determines the care to be |
8-1 |
medically necessary: |
8-2 |
     (i) Habilitative or rehabilitative care; |
8-3 |
     (ii) Pharmacy care; |
8-4 |
     (iii) Psychiatric care; |
8-5 |
     (iv) Psychological care; and |
8-6 |
     (v) Therapeutic care. |
8-7 |
     (b)(1) Every health maintenance organization contract, plan, or policy delivered, issued |
8-8 |
for delivery or renewed in this state shall provide coverage for the diagnosis and treatment of |
8-9 |
autism spectrum disorders. No insurer shall terminate coverage, or refuse to deliver, execute, |
8-10 |
issue, mend, adjust, or renew coverage to an individual solely because the individual is diagnosed |
8-11 |
with one of the autism spectrum disorders or has received treatment for autism spectrum |
8-12 |
disorders. |
8-13 |
     (2) The coverage required under this section shall not be subject to dollar limits, |
8-14 |
deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, |
8-15 |
deductibles, or coinsurance provisions that apply to physical illness generally under the health |
8-16 |
insurance policy. |
8-17 |
     (3) Coverage under this section shall not be subject to any limits on the number of visits |
8-18 |
an individual may make to an autism services provider. |
8-19 |
     (4) This section shall not be construed as limiting benefits that are otherwise available to |
8-20 |
an individual under a health insurance policy. |
8-21 |
     SECTION 5. This act shall take effect upon passage. |
      | |
======= | |
LC00106 | |
======= | |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS | |
*** | |
9-1 |
     This act would require coverage for the diagnosis and treatment of autism spectrum |
9-2 |
disorders. |
9-3 |
     This act would take effect upon passage. |
      | |
======= | |
LC00106 | |
======= |