2010 -- S 2422

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LC01432

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2010

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A N A C T

RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND AUTISM SPECTRUM

DISORDER INTERVENTION AND TREATMENT ACT

     Introduced By: Senators E O`Neill, Pinga, Cote, Raptakis, and Maher

     Date Introduced: February 11, 2010

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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     CHAPTER 84

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THE RHODE ISLAND AUTISM SPECTRUM DISORDER INTERVENTION AND

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TREATMENT ACT

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     23-84-1. Short title. – This chapter shall be known and may be cited as “The Rhode

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Island Autism Spectrum Disorder Intervention and Treatment Act.”

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     23-84-2. Legislative findings. – It is hereby found and declared as follows:

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     (1) Despite earlier efforts, the number of diagnoses of Autism Spectrum Disorder

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("ASD") continues to increase. At the same time, programs have developed which impose layers

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of response and treatment which are unnecessarily delay and prolong the entry of children into

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treatment and the delivery of that treatment.

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     (2) Existing protocols for the delivery of treatment need to be revised to allow referral by

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primary care physicians directly to those who will provide treatment.

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     23-84-3. Implementation. – (a) The department of health and the department of human

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services are directed to revise their protocols for the delivery of Autism Spectrum Disorder

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treatment to eliminate unnecessary layers of response and allow referral by primary care

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physicians directly to those who will actually provide treatment. In implementing this goal, said

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protocols shall provide for treatment to begin within one week after the initial diagnosis.

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     (b) The state institutions of higher education are directed to evaluate whether its current

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nursing, physical therapy (PT), occupational therapy (OT) and occupational therapy assistant

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(OTA) programs offer sufficient preparation for those who may be called upon to interact with

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ASD patients and their families, and to present a plan on or before January 1, 2011 to address any

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deficiencies, including whether scholarship or other financial assistance incentives are needed to

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encourage study in this field.

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     SECTION 2. Title 27 of the General Laws entitled "INSURANCE" is hereby amended

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by adding thereto the following chapter:

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     CHAPTER 38.3

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INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER

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     27-38.3-1. Autism spectrum disorder coverage. -- Every health care insurer that

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delivers or issues for delivery or renews in this state a contract, plan, or policy except contracts

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providing supplemental coverage to Medicare or other governmental programs, shall provide

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coverage for the medical treatment of Autism Spectrum Disorder (ASD) under the same terms

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and conditions as that coverage is provided for other illnesses and diseases. Insurance coverage

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offered pursuant to this statute must include the same durational limits, amount limits,

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deductibles, and co-insurance factors for mental illness as for other illnesses and diseases.

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     27-38.3-2. Definitions. -- For the purposes of this chapter, the following words and terms

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have the following meanings:

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     (1) "Health insurers" means all persons, firms, corporations, or other organizations

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offering and assuring health services on a prepaid or primarily expense-incurred basis, including,

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but not limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title,

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nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title

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or under any public law or by special act of the general assembly, health maintenance

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organizations, or any other entity which insures or reimburses for diagnostic, therapeutic, or

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preventive services to a determined population on the basis of a periodic premium. Provided, this

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chapter does not apply to insurance coverage providing benefits for:

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     (i) Hospital confinement indemnity;

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     (ii) Disability income;

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     (iii) Accident only;

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     (iv) Long-term care;

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     (v) Medicare supplement;

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     (vi) Limited benefit health;

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     (vii) Specific disease indemnity;

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     (viii) Sickness or bodily injury or death by accident or both; and

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     (ix) Other limited benefit policies.

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     (2) "Autism Spectrum Disorder (ASD)" is hereby defined as a neurological and

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developmental disorder, and not a "mental illness" as defined in section 27-38.2-2, and health

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insurers are directed to adopt a separate code for ASD.

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     27-38.3-3. Medical necessity and appropriateness of treatment. -- (a) Upon request of

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the reimbursing health insurers, all providers of treatment of Autism Spectrum Disorder (ASD)

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shall furnish medical records or other necessary data which substantiates that initial or continued

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treatment is at all times medically necessary and appropriate. When the provider cannot establish

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the medical necessity and/or appropriateness of the treatment modality being provided, neither

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the health insurer nor the patient shall be obligated to reimburse for that period or type of care

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that was not established. The exception to the preceding can only be made if the patient has been

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informed of the provisions of this subsection and has agreed in writing to continue to receive

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treatment at his or her own expense.

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      (b) The health insurers, when making the determination of medically necessary and

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appropriate treatment, must do so in a manner consistent with that used to make the determination

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for the treatment of other diseases or injuries covered under the health insurance policy or

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agreement.

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      (c) Any subscriber who is aggrieved by a denial of benefits provided under this chapter

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may appeal a denial in accordance with the rules and regulations promulgated by the department

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of health pursuant to chapter 17.12 of title 23.

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     27-38.3-4. Limitations of coverage. -- The health care benefits outlined in this chapter

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apply only to services delivered within the State of Rhode Island; provided, that all health

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insurers shall be required to provide coverage for those benefits mandated by this chapter outside

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of the State of Rhode Island where it can be established through a pre-authorization process that

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the required services are not available in the State of Rhode Island from a provider in the health

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insurer's network.

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      SECTION 3. This act shall take effect upon passage.

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LC01432

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND AUTISM SPECTRUM

DISORDER INTERVENTION AND TREATMENT ACT

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     This act would direct the departments of health and human services to prepare an

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accelerated intervention plan for dealing with Autism Spectrum Disorder (ASD) and would

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further provide that health insurance policies must cover ASD treatment.

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     This act would take effect upon passage.

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LC01432

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