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3 JAN 2008; UPDATED 21 MAY 2008-- DRAFT IN CONTINUING PROGRESS; NOT FINAL VERSION
SUMMARY OF U.S. STATES' INSURANCE BILLS IN PROGRESS/PROJECTED, CURRENT STATUTE, RELEVANT COURT CASE, MEDICAID, AND OTHER AUTISM-RELATED ENACTMENTS Regina Claypool-Frey, 3 January, 2008, 26 Jan 2008, 30 Jan 2008, 18 Feb 2008, 21Feb2008, 25Feb2008, 27Feb2008, 1 Mar, 2008, 6 Mar, 2008, 7 March 2008, 14 March 2008, 24 March 2008, 1 May 2008, 14 May 2008, 21 May 2008
Disclaimer: Summary is for informal informational purposes and makes no claim to being comprehensive or current information; it neither constitutes legal or insurance advice nor representation of the organizations or individuals listed therein. Readers are encouraged to read the original texts of the bills and information at legislative or cited links and to contact your state’s insurance division or other appropriate entity.
Some state info is "In progress". If you know of additional bills or statute that is omitted/should be included, or corrections to this webpage
TABLE OF CONTENTS
Click on topic to jump down to more information
BILLS AND LEGISLATIVE ACTIVITY
Disclaimer
Disclaimer: Summary is for informal informational purposes and makes no claim to being comprehensive or current information; it neither constitutes legal or insurance advice nor representation of the organizations or individuals listed therein. Readers are encouraged to read the original texts of the bills and information at legislative or cited links and to contact your state’s insurance division or other appropriate entity.
Table of states with mandates in place and mandate bills - in progress
Table updated 24March2008.
| Total | Est. cost | AK | AL | AR | AZ | CO | CT | DC | DE | FL | GA | HI | IA | ID | IL | IN | KS | KY | LA | MA | MD | ME | MI | MN | MO | MS |
| 14 laws | <1% | L | B | B | B | B | B | |||||||||||||||||||
| MT | NC | ND | NE | NH | NJ | NM | NV | NY | OH | OK | OR | PA | RI | SC | SD | TN | TX | UT | VA | VT | WA | WI | WV | WY | ||
| B | B | (2) | B | (2) | B |
(1)Health Insurance Mandates in the States 2007
Council for Affordable Insurance
Note: this document lists ALL mandated coverages including providers and special groups such as adopted children.
It does not differentiate between simple parity coverage and more comprehensive treatment laws, nor between those defining autism as mental health, neurologic disorder or biologically based disorder.
(2)Bills passed into law after publication of (1)
(3) Health Insurance Mandates in the States 2008
Council for Affordable Insurance
Note: this document lists ALL mandated coverages including providers and special groups such as adopted children.
It does not differentiate between simple parity coverage and more comprehensive treatment laws, nor between those defining autism as mental health, neurologic disorder or biologically based disorder.
L= bills signed into LAW
B=active bills in legislature
B = bills submitted,died in committee, deferred for further study until next session, amended into another form, or otherwise not passed as an insurance mandate after 1 JAN 08.
Notation (Autism Speaks)
"(Autism Speaks)" indicates a bill being targeted for support by the organization Autism Speaks Inc. as part of its plan of graduated support. Criteria at this time is, size of the state, active autism community and a moderate Governor. The insurance legislation supported by Autism Speaks specifically targets coverage of Applied Behavior Analysis (ABA) and other structured behavioral therapies
How Private Health Coverage Works: A Primer – 2008 Update
Statement on Evidence Base for ABA Interventions with links to cited articles.
Adapted from "Applied Behavior Analysis and Neurodevelopmental Disorders: Overview and Summary of Scientific Support"
Authors: Louis P. Hagopian & Eric W. Boelter
The Kennedy Krieger Institute and Johns Hopkins University School of Medicine
Micheletti v. State Health Benefits Commission, esp. rel. habilitative vs. rehabilitative
I wanted to share this because although the ruling itself has only regional significance, I think there is something interesting in the way that "developmental" is described in the ruling and believe that it has pertinence to the arguments of rehabilitative vs. habilitative, or as noted "restorative" vs. "non-restorative" in regards to children, esp. young children.
http://lawlibrary.rutgers.edu/courts/appellate/a4418-05.opn.html
Micheletti v. State Health Benefits Commission
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-4418-05T2
389 N.J. Super. 510, 913 A.2d 842.
"...Far from accepting the SHBC contention that the exclusion of the prescribed therapy for Jake is clearly set forth in the NJPLUS contract, we find the exclusionary language to be ambiguous, as witnessed by the fact that Horizon initially approved speech therapy. Furthermore, the SHBC interpretation foreclosing non-restorative benefits is undercut by another Handbook provision indicating that speech therapy is covered after surgery "to correct a defect that existed at birth and impaired the ability to speak or would have impaired the ability to speak."
In addition, while the Handbook excludes treatment for development of a function or skill beyond that previously demonstrated, there is no definition of "development" or "developmental. " Children are constantly developing. "Developmental" defines childhood. The words "restorative" and "non-restorative" when used in this context are also ambiguous and largely inapplicable to infants and young children. Every child is born with the potential to develop those skills necessary to life in society. Autistic children and other children afflicted with BBMIs are hindered from achieving that potential. The treatment for Jake can restore some of his potential. Even with the therapies described, Jake's prognosis is uncertain, but there is no claim that the treatment is futile. To the contrary, there is the expectation that, to some degree, he will share the skills and functions of more fortunate children, including his siblings.
The prescribed treatment for Jake is traditional, not exotic or wasteful of resources. See footnote 3 Nor can we assume that inclusion of occupational or speech therapy for the small number of autistic children will significantly affect the fiscal burden of the State Health Benefits Program or hinder the mission of the SHBC to provide a comprehensive health program for State employees and their dependents at reasonable cost. We find no legislative goals to be advanced by the denial of the benefits sought and no statutory authority to do so. The decision of the SHBC is antithetical to the purpose and spirit of the State Health Benefits Program, the reasonable expectation of its participants, the legislative intention of equal treatment for BBMIs and the public policy of this State for the nurturing of children.
We hold the exclusions relied upon by the SHBC to deny coverage for the treatment sought for autism are void. We direct that speech and occupational therapy be instituted for Jake without delay, and that the date of coverage is retroactive to the date of the initial petition..."
ABA not experimental or investigational STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH
OFFICE OF FINANCIAL AND INSURANCE SERVICES
Before the Commissioner of Financial and Insurance Services
In the matter of
XXXXX
Petitioner File No. 85641-001
v
Blue Cross Blue Shield of Michigan
Respondent
______________________________________/
Excerpt:
p.4.
"..denial was based on these two exclusions found in Section 9 of the
certificate (pages 9.1 and 9.2):
� educational care and cognitive therapy;
- * *
� services and supplies that are not medically necessary according to
accepted standards of medical practice including any services which
are experimental or investigational in nature[.].."
The question of whether the Petitioner's ABA therapy is
investigational or experimental for treatment of the Petitioner's
condition was presented to an IRO for analysis as required by section
11(6) of PRIRA, MCL 550.1911(6). The IRO physician reviewer is
certified by the American Board of Pediatrics; certified by the
American Board of Psychiatry and Neurology as a diplomate in the
specialty of neurology with special competence in child neurology; a
member of the American Academy of Neurology; and in active practice.
The IRO reviewer said that ABA is an accepted and effective treatment
for autism and indicated that it is no longer investigational for
treatment of the Petitioner's condition. The IRO
File No. 85641-001
Page 5
reviewer included lengthy excerpts from an overview of applied
behavioral analysis from the Kennedy-Krieger Institute at the Johns
Hopkins University School of Medicine, and the conclusion of that
overview (and of the IRO reviewer) is that ABA (my emphasis) IS A
STANDARD AND EFFICACIOUS THERAPY AND NOT CONSIDERED TO BE EXPERIMENTAL
OR INVESTIGATIONAL.
The Commissioner is not required in all instances to accept the IRO's
recommendation. However, the IRO recommendation is afforded deference
by the Commissioner; in a decision to uphold or reverse an adverse
determination, the Commissioner must cite "the principal reason or
reasons why the commissioner did not follow the assigned independent
review organization's recommendation." MCL 550.1911(16) (b). The IRO
reviewer's analysis is based on extensive expertise and professional
judgment and the Commissioner can discern no reason why the
recommendation should be rejected in the present case. Therefore, the
Commissioner accepts the IRO reviewer's conclusion and finds that ABA
therapy is not experimental or investigational.
BCBSM's second argument is that ABA therapy is excluded because the
certificate excludes "educational care and cognitive therapy." That
was the reason MESSA gave when it initially denied coverage in its May
24, 2007, letter to the Petitioner's mother. Neither MESSA nor BCBSM
provided any explanation for why they thought this exclusion applied
in the Petitioner's case, and the terms "educational care" and
"cognitive therapy" are not defined or discussed in the certificate or
in any material submitted as part of this review.
Based on the January 21, 2007, letter written by XXXXX, PhD, the
Petitioner's psychologist at Beaumont Hospital, the Commissioner finds
that the services he received were (my emphasis) NOT "EDUCATIONAL
CARE." The Commissioner's finding is based on Dr. XXXXX's description
of those services as "intensive psychotherapeutic intervention" that
(my emphasis) ADHERES TO CLINICAL GUIDELINES AND IS STRUCTURED FOR THE
INDIVIDUAL'S SPECIFIC PROBLEMS AND ACTIVELY INVOLVES THE PETITIONER'S
PARENTS. THE COMMISSIONER DOES NOT FIND THIS TO BE A DESCRIPTION OF
"EDUCTIONAL CARE."
Page 6
The Commissioner also finds that the Petitioner's ABA therapy was (my
emphasis)NOT "COGNITIVE THERAPY." In the overview of applied
behavioral analysis from the Kennedy-Krieger Institute cited by the
IRO reviewer is this discussion:
ABA-based interventions are essentially a highly specialized type of
Behavior Therapy that place greater emphasis on more precisely
defining and recording behavior, and the use of highly rigorous
methods for clinical treatment evaluation. Emphasizing the focus on
experimental methodology, Baer, Wolf, and Risley (1968) defined the
criteria for what constitutes ABA-based procedures, specifically
ABA-based procedures must: 1) involve an analysis of socially
important behavior in a manner in which the behavior is operationally
defined and explicitly and reliably measured so that a believable
demonstration of the events responsible for the occurrence of the
behavior is produced; 2) alter the targeted behavior enough to produce
a meaningful change (i.e., a clinically significant improvement) and
provide for the generalization of the behavior change; and 3) employ
procedures that are tied to well established principles of behavioral
science (i.e., operant learning). Underlining added
Furthermore, cognitive therapy is defined in Merriam-Webster's Online
Dictionary as "psychotherapy especially for depression that emphasizes
the substitution of desirable patterns of thinking for maladaptive or
faulty ones."1 (my emphasis)FROM THIS, THE COMMISSIONER CONCLUDES THAT
ABA IS BEHAVIOR THERAPY, NOT COGNITIVE THERAPY.
In summary, the Commissioner finds that neither of the two exclusions
cited by BCBSM applies in this case and therefore the Petitioner's ABA
therapy is presumptively a covered benefit under the certificate..."
FULL FINDING:
http://www.mi.gov/documents/dleg/85641_BCBSM_11-27-07.pdf_222301_7.pdf
FEDERAL BILL HR 5028 Require group health plans to cover PDDs/autism
Introduced 1/16/08
Title: To amend the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code of 1986 to require that group health plans provide coverage for pervasive developmental disorders such as autism.
Sponsor: Rep Wexler, Robert FL-19 (introduced 1/16/2008) Cosponsors (None)
Latest Major Action: 1/16/2008 Referred to House committee. Status: Referred to the Committee on Education and Labor, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
ARIZONA (see LAW below)
related Arizona HB2470 Licensing of Behavior Analysts: original version
2/21/08 Amended version 2/20/08
Arizona HB2470
BEHAVIOR ANALYST BOARD
To track bill status/actions to date
2470 in "Bill Number Search"
Date: 4/8/08 Status
AZ HB 2470 Board of Behavior Analysts
4/3/08 Passed in Senate Health Committee--Recommendation: Do pass as amended
5-1-1
Still in Rules committee.
http://www.azleg.gov/FormatDocument.asp?inDoc=/legtext/48leg/2r/bills/hb2470o.asp
COMMITTEE ON HEALTH
HOUSE OF REPRESENTATIVES AMENDMENTS TO H.B. 2470
(Reference to printed bill)
http://www.azleg.gov/legtext/48leg/2r/adopted/h.2470-se-health.doc.htm
Amend title to conform
and, as so amended, it do pass
BOB STUMP
Chairman
2470-se-health
2/20/08
H:jjb
===================================
HB 2470
Introduced by Rep. Bradley; Stump, Senator Bee
An Act Amending Title 21, Chapter 33, Arizona Revised Statutes, by Adding Article 9; Relating to Behavior Analysts.
(Defines Licensed Behavior Analysts; qualification; Definition).
CONNECTICUT - HB 5696 Passed-Sub/File no. 187 covers OT, PT Speech; ABA deleted.
Substitute House bill 5696/File No. 187 passed. Retains physical therapy, speech therapy and occupational therapy. Delete ABA and habilitative clause.
http://www.cga.ct.gov/2008/FC/2008HB-05696-R000187-FC.htm
2/26/08 Referred to Joint committee on Insurance and Real Estate
3/6/08 Public Hearing
"...habilitation care based on the principles of Applied Behavioral Analysis.."
==================
Autism Insurance Bill Introduced in Connecticut State Legislature
Connecticut is the latest state to introduce legislation which will amend insurance statutes to include coverage for autism. Proposed by State Representative Brian O'Connor (D-Clinton, Killingworth, Westbrook), Chairman of the Insurance and Real Estate Committee, HB-5696 requires all Connecticut healthcare policies to cover such therapies as habilitation care; psychiatric care; therapeutic care, such as speech and occupational therapy; Applied Behavioral Analysis (ABA) and medications prescribed by a physician.
The policies would cover these treatments until the insured turns 26. A hearing on the bill is scheduled for March 6. "
FLORIDA (See LAW below)
Related: HB 19 A mental health parity bill
FL House HB 19 Coverage for Mental, Nervous, and Substance-related disorders.
In committee on Health Innovation, Monday, 11, 2008
A bill to be entitled
2 An act relating to coverage for mental, nervous, and
3 substance-related disorders; amending s. 627.668, F.S.;
4 revising requirements for optional coverage for mental,
5 nervous, and substance-related disorders; revising certain
6 benefits limitations; providing an options application
7 requirement; repealing s. 627.669, F.S., relating to
8 optional coverage required for substance abuse impaired
9 persons; amending s. 627.6675, F.S.; conforming a cross10
reference; providing an effective date.
Appears to be a parity bill.
IDENTICAL TO SB 164
ILLINOIS SB 1900 Specifies but not limited to Applied Behavior Analysis
1/10/08 Referred to Rules Committee
p.4
"1. adding Section 356z.11 as follows:
2(215 ILCS 5/356z.11 new)
3 Sec. 356z.11. Autism spectrum disorders.
4 (a) A group or individual policy of accident and health
5 insurance or managed care plan amended, delivered, issued, or
6 renewed after the effective date of this amendatory Act of the
7 95th General Assembly must provide individuals under 21 years
8 of age coverage for the diagnosis of autism spectrum disorders
9 and for the treatment of autism spectrum disorders to the
10 extent that the diagnosis and treatment of autism spectrum
11 disorders are not already covered by the policy of accident and
12 health insurance or managed care plan.
13 (b) Coverage provided under this Section shall be subject
14 to a maximum benefit of $36,000 per year, but shall not be
15 subject to any limits on the number of visits to an autism
16 service provider.
(...)
p.5
21 "Treatment for autism spectrum disorders" shall include
22 the following care prescribed, provided, or ordered for an
23 individual diagnosed with an autism spectrum disorder by a
24 licensed physician, licensed psychologist, or certified
25 registered nurse practitioner if the care is determined to be
26 medically necessary:
p.6
1(i) Psychiatric care.
2(ii) Psychological care.
3 (iii) Rehabilitative care.
4 (iv) Therapeutic care, including speech, occupational,
5 and physical therapy.
6 (v) Pharmacy care.
7 (vi) Applied behavior analysis therapy.
8 (vii) Any care, treatment, intervention, service or
9 item for individuals with an autism spectrum disorder which
10 is determined by the Department of Health Care and Family
11 Services, based upon its review of best practices or
12 evidenced-based research, to be medically necessary..."
See also:Autism Speaks: Autism Insurance Bill Introduced in Illinois State Legislature
KANSAS SB398- A Mental Health Parity Bill
AN ACT concerning insurance; providing coverage for autism; amending
K.S.A. 2007 Supp. 40-2,103, 40-2,105, 40-2,105a and 40-19c09 and
repealing the existing sections.
A mental health parity law.
SB406 KS Autism Service Scholarship Program
A"N ACT concerning colleges and universities; relating to fees and tui-
tion; establishing the autism service scholarship program.
Be it enacted by the Legislature of the State of Kansas:
Section 1. Sections 1 through 8, and amendments thereto, shall be
known and may be cited as the autism service scholarship program act.
The provisions of the autism service scholarship program act shall expire
on June 30, 2013...."
LOUISIANA HB 958 Requires diagnosis treatment of ASD
LA HB958
Author: Representative Foil
Requires health insurance coverage of the diagnosis and treatment of
autism spectrum disorders in individuals under 21 years of age.
Bill History:
04-30-08 H Meeting set for 9:30 A.M. RM. 2 House Insurance
03/31/2008 H 104 Read by title, under the rules, referred to the
Committee on Insurance.
03/21/2008 H Under the rules, provisionally referred to the Committee
on Insurance.
03/21/2008 H Prefiled.
MASSACHUSETTS Related H2244,SD2039Licensing of Behavior Analysts
MA
H2244, SD2039 - An Act relative to behavior analysts
http://www.arcmass.org/StateHousePolicy/behavioranalysts/tabid/603/Default.aspx
MICHIGAN HB5529, SB784, HB5527, SB785 (Autism Speaks)
December 4, 2007, Introduced by Reps. Ball, Johnson, Byrnes, Vagnozzi, Wojno, Kathleen Law, Hopgood, Polidori, Corriveau and Dean and referred to the Committee on Health Policy.
"...An expense-incurred hospital, medical or surgical policy or certificate delivered, issued for delivery, or renewed in this state and a health maintenance organization contract shall provide coverage for the treatment of autism spectrum disorder, including, but not limited to coverage for therapeutic evaluations and interventions, speech therapy, occupational therapy, physical therapy, intensive early intervention, applied behavioral analysis, and Lovaas behavioral therapy..."
September 19, 2007, Introduced by Senators Hunter, Brater, Basham, Olshove, Scott and Gleason and referred to the Committee on Health Policy
December 4, 2007, Introduced by Reps. Angerer, Shaffer, Spade, Tobocman, Espinoza, Johnson, Byrnes, Vagnozzi, Wojno, Kathleen Law, Hopgood, Polidori, Corriveau and Dean and referred to the Committee on Health Policy.
"...A health care corporation group or nongroup certificate shall provide coverage for the treatment of autism spectrum disorder, including, but not limited to coverage for therapeutic evaluations and interventions, speech therapy, occupational therapy, physical therapy, intensive early intervention, applied behavioral analysis, and Lovaas behavioral therapy..."
September 19, 2007, Introduced by Senators Hunter, Brater, Basham, Olshove, Scott and Gleason and referred to the Committee on Health Policy
See also
Autism Insurance in Michigan (AIM) blogspot
MISSOURI HB2351 and SB1229 ABA health insurance reimbursement
4/23/08 Section in progress. To add additional insurance bills
Missouri proposed bills for applied behavior analysis health insurance
reimbursement:
"...7. The department of health and senior services shall establish
standards to be utilized by health benefit plans for the credentialing
of autism service providers. The department of health and senior
services may require that health benefit plans grant credentials to any
autism services provider whom the department of health and senior
services determines meets or exceeds the department of health and senior
services' credentialing standards..."
==============
Autism legislation takes center stage
Wednesday, April 16, 2008, 8:50 AM
By Jon Allison
http://www.missourinet.com/gestalt/go.cfm?objectid=578341E1-C633-7615-4467876EF77DEB7F
2 SB1122 - Mandates insurance coverage for the treatment of autism and requires the offering of group insurance coverage for prosthetic devices
SB 1122. Mandates insurance coverage for the treatment of autism and requires the offering of group insurance coverage for prosthetic devicesSponsor:. Ridgeway. LR Number:. 5022S.01I. Fiscal Note:. 5022-01. Committee:. Small Business, Insurance & Industrial Relations. Last Action:. 4/15/2008 - SCS Voted Do Pass (w/SCS/SBs 1122 & 789) S Small Business, Insurance & Industrial Relations Committee (5022S.02C)Journal Page:. Title:. Calendar Position:. Effective Date:. List of 2008 Senate Bills.
http://www.house.mo.gov/billtracking/bills081/bills/sb1122.htm - Last Modified: 4/21/2008 11:10:47 PM
3 SB1229 - Requires certain health carriers to provide insurance coverage for the diagnosis and treatment of autism spectrum disorder under certain conditions
SB 1229. Requires certain health carriers to provide insurance coverage for the diagnosis and treatment of autism spectrum disorder under certain conditionsSponsor:. Koster. Co-Sponsor(s). LR Number:. 5342S.01I. Fiscal Note:. Committee:. Pensions, Veterans' Affairs and General Laws. Last Action:. 2/28/2008 - Second Read and Referred S Pensions, Veterans' Affairs and General Laws Committee. Journal Page:. S415. Title:. Calendar Position:. Effective Date:. List of 2008 Senate Bills.
http://www.house.mo.gov/billtracking/bills081/bills/sb1229.htm - Last Modified: 4/21/2008 11:11:06 PM
5 HB 1753 - HEALTH INSURANCE COVERAGE FOR AUTISM - Lampe, Sara
House Home Page. House Bill List. HB 1753. Requires health benefit plans to include coverage for the treatment of autism spectrum disorders. Sponsor:. Lampe, Sara (138). Proposed Effective Date:. 08/28/2008. CoSponsor:. Low, Beth (39). etal.. LR Number:. 3884L.01I. Last Action:. 02/28/2008 -. Referred: Special Committee on Health Insurance (H). HB1753. Next Hearing:. Hearing not scheduled. Calendar:. Bill currently not on a calendar. ACTIONS. HEARINGS. CALENDAR. Bill Summaries for HB1753.
http://www.house.mo.gov/billtracking/bills081/bills/hb1753.htm - Last Modified: 4/21/2008 7:33:53 PM
7 HB 2265 - HEALTH INSURANCE COVERAGE FOR AUTISM - Grisamore, Jeff
House Home Page. House Bill List. HB 2265. Requires health benefit plans to include coverage for the treatment of autism spectrum disorders. Sponsor:. Grisamore, Jeff (47). Proposed Effective Date:. 08/28/2008. CoSponsor:. Pratt, Bryan (55). etal.. LR Number:. 3746L.01I. Last Action:. House Committee:. HEALTH CARE POLICY. 04/15/2008 - Public Hearing Completed (H). HB2265. Next Hearing:. Hearing not scheduled. Calendar:. Bill currently not on a calendar. ACTIONS. Bill Summaries for HB2265.
http://www.house.mo.gov/billtracking/bills081/bills/hb2265.htm - Last Modified: 4/21/2008 7:34:28 PM
10 HB 2351 - HEALTH INSURANCE COVERAGE FOR AUTISM - Page, Sam
House Home Page. House Bill List. HB 2351. Requires health carriers and health benefit plans to provide coverage for the diagnosis and treatment of autism spectrum disorders under certain conditionsSponsor:. Page, Sam (82). Proposed Effective Date:. 08/28/2008. CoSponsor:. Lampe, Sara (138). etal.. LR Number:. 5413L.01I. Last Action:. House Committee:. HEALTH CARE POLICY. 04/15/2008 - Public Hearing Completed (H). HB2351. Next Hearing:. Hearing not scheduled. Bill currently not on a calendar.
http://www.house.mo.gov/billtracking/bills081/bills/hb2351.htm - Last Modified: 4/21/2008 7:34:34 PM
Related: SB768 - Creates the Missouri Commission on Autism Spectrum Disorders and the Office of Autism Services
SB 768. Creates the Missouri Commission on Autism Spectrum Disorders and the Office of Autism Services. Sponsor:. Rupp. Co-Sponsor(s). LR Number:. 3524S.08P. Fiscal Note:. 3524-08. Committee:. Seniors, Families and Public Health. Last Action:. 4/17/2008 - Referred H Health Care Policy Committee. Journal Page:. H992. Title:. SS SCS SB 768. Calendar Position:. Effective Date:. August 28, 2008. Full Bill Text. All Actions. Available Summaries. Senate Home Page. List of 2008 Senate Bills.
http://www.house.mo.gov/billtracking/bills081/bills/sb768.htm - Last Modified: 4/21/2008 11:09:42 PM
Related: SB1127 - Establishes the Office of Autism Services
SB 1127. Estabilishes the Office of Autism Services. Sponsor:. Rupp. Co-Sponsor(s). LR Number:. 5070S.01I. Fiscal Note:. 5070-01. Committee:. Seniors, Families and Public Health. Last Action:. 3/4/2008 - Hearing Conducted S Seniors, Families and Public Health Committee. Journal Page:. Title:. Calendar Position:. Effective Date:. August 28, 2008. Full Bill Text. All Actions. Available Summaries. Senate Home Page. List of 2008 Senate Bills. Current Bill Summary. SB 1127 - This act establ
http://www.house.mo.gov/billtracking/bills081/bills/sb1127.htm - Last Modified: 4/21/2008 11:10:48 PM
Related: HB 2304 - AUTISM SPECTRUM DISORDER - Lampe, Sara
House Home Page. House Bill List. HB 2304. Changes the laws regarding the identification, assessment, and education of children with autism spectrum disorderSponsor:. Lampe, Sara (138). Proposed Effective Date:. 08/28/2008. CoSponsor:. Grisamore, Jeff (47). etal.. LR Number:. 5266L.01I. Last Action:. 04/03/2008 -. Referred: Elementary and Secondary Education (H). HB2304. Next Hearing:. Hearing not scheduled. Calendar:. Bill currently not on a calendar. ACTIONS. Bill Summaries for HB2304.
http://www.house.mo.gov/billtracking/bills081/bills/hb2304.htm - Last Modified: 4/21/2008 7:34:31 PM
Related: HB 2075 - AUTISM SPECTRUM DISORDERS - Grisamore, Jeff
House Home Page. House Bill List. HB 2075. Establishes the Missouri Commission on Autism Spectrum Disorders. Sponsor:. Grisamore, Jeff (47). Proposed Effective Date:. 08/28/2008. CoSponsor:. Pratt, Bryan (55). etal.. LR Number:. 4716L.02I. Last Action:. 02/28/2008 -. Referred: Health Care Policy (H). HB2075. Next Hearing:. Hearing not scheduled. Calendar:. Bill currently not on a calendar. ACTIONS. HEARINGS. CALENDAR. FISCAL NOTES. Bill Summaries for HB2075. Introduced. Bill Text for HB2075.
http://www.house.mo.gov/billtracking/bills081/bills/hb2075.htm - Last Modified: 4/21/2008 7:34:16 PM
Related: HB 2376 - AUTISM SPECTRUM DISORDER - Grisamore, Jeff
House Home Page. House Bill List. HB 2376. Changes the laws regarding the identification, assessment, and education of children with autism spectrum disorder
Sponsor:. Grisamore, Jeff (47). Proposed Effective Date:. 08/28/2008. CoSponsor:. Lampe, Sara (138). etal.. LR Number:. 5420L.01I. Last Action:. 03/27/2008 -. Referred: Elementary and Secondary Education (H). HB2376. Next Hearing:. Hearing not scheduled. Calendar:. Bill currently not on a calendar. ACTIONS. Bill Summaries for HB2376.
http://www.house.mo.gov/billtracking/bills081/bills/hb2376.htm - Last Modified: 4/21/2008 7:34:35 PM
Related: SB993 - Creates the Missouri Special Needs Scholarship Tax Credit Program
SB 993. Creates the Missouri Special Needs Scholarship Tax Credit Program. Sponsor:. Crowell. LR Number:. 4227S.03C. Fiscal Note:. 4227-03. Committee:. Pensions, Veterans' Affairs and General Laws. Last Action:. 4/21/2008 - S Informal Calendar S Bills for Perfection-SBs 993 & 770-Crowell, with SCS, SS for SCS, SA 4 & SSA 1 for SA 4 (pending)Journal Page:. Title:. SCS SBs 993 & 770. Calendar Position:. Effective Date:. August 28, 2008. Full Bill Text. All Actions. List of 2008 Senate Bills.
http://www.house.mo.gov/billtracking/bills081/bills/sb993.htm - Last Modified: 4/21/2008 11:10:24 PM
NEW JERSEY A2238 Requires coverage of applied behavioral analysis
FYI: The 6 bill package (A2238, A2256, A2257, A2258, A2259, AR105) has
been released from committee. Five out of the six went to second
reading, but A2238 has been referred to the Assembly Appropriations
Committee.
To search for bills by number, keyword or subject
http://www.njleg.state.nj.us/bills/bills0001.asp
A2238
1) Require health insurers to cover certain autism-related therapies
and treatment, known as applied behavioral analysis (A-2238, released
7-0-3), sponsored by Prieto, Roberts, and Voss;
2/25/2008 Introduced, Referred to Assembly Health and Senior Services
Committee
2/25/2008 Reported and Referred to Assembly Appropriations Committee
http://www.njleg.state.nj.us/committees/assembly.asp
------------ --------- --------- --------
AUTISM PROPOSALS MOVE AHEAD IN TRENTON
"...While all at the committee hearing lauded the good intention of
the bills, questions arose about some unintended consequences.
David A. Smith, lobbying for the New Jersey Association of Health
Plans, said new mandates in health insurance programs would drive up
insurance costs for small businesses across the state.
"When you move a mandate bill forward, there are consequences. There
are cost increases," said Smith.
The bill (A2238) would mandate coverage of physical, occupational,
speech and behavioral therapies used to improve social interaction and
increase communication. A state Supreme Court decision last year
allowed for public employee health insurance programs to include these
therapies.
Suzanne Buchanan, clinical services director at The New Jersey Center
for Outreach and Services for the Autism Community, said requiring
these treatments is essential.
"To me, it's not the icing on the cake. It is the cake," said Buchanan..."
http://www.courierpostonline.com/apps/pbcs.dll/article?AID=/20080225/NEWS01/80225043/1006
OHIO HB 170 — no specific treatment or therapy specified.
Sponsors: Representatives Peterson and Celeste. Introduced April 2007. Currently in House Insurance Committee
"A multiple employer welfare arrangement that ... and that operates a group self-insurance program may be established only if any of the following applies:
(1) The arrangement has and maintains a minimum enrollment of three hundred employees of two or more employers.
(2) The arrangement has and maintains a minimum enrollment of three hundred self-employed individuals.
(3) The arrangement has and maintains a minimum enrollment of three hundred employees or self-employed individuals in any combination of divisions (A)(1) and (2) of this section.no individual or group health insuring corporation policy, contract, or agreement providing basic health care services that is delivered, issued for delivery, or renewed in this state shall exclude coverage for the diagnosis and treatment of autism...
(C) A violation of this section is an unfair and deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code..."
OKLAHOMA Change 2/21/08 HB2459 House version Nick's Law
"The Oklahoma Senate has until Thursday, March 13th to vote on legislation before moving it over to the House. This would include the bills that have or will have Nick's Law as part of the legislation.
Senator Jay Paul Gumm has filed amendments on 6 bills currently and is working on several other pieces of legislation.
5 of these bills are currently on the agenda for the week of March 3-6th. The include (3/7/08 SB 2114), SB 2118, SB 2119, SB 2102, and SB 1895. Senator Gumm's SB 1407 will also include Nick's Law as an amendment, but that bill is positioned to be heard by the entire Senate the week of March 10-13th."
"...Senators Gumm and Anderson decided on Thursday, Feb 21st, NOT to present SB 1537 – Nick’s Law - in the Senate Insurance Committee, for fear that it would be voted down. Senate rules prohibit the language of any bills that were voted down in committee from being used in other bills for the rest of the year. The deadline to hear Senate bills in committee was Thursday, so technically, SB 1537 is dead.
But our Senate authors have vowed to find other germaine bills in which to insert the languagecontained in SB 1537. So Nick’s Law will now be sent to the entire bodyof the Senate as an amendment on another insurance bill. The senators’ decision givesthe language of Nick’s Law several more options for passage out of theSenate. The actual bill or bills that Nick’s Law will be amended into will be determined in the next several days. We have 3 weeks to vote the bill out of the Senate (deadline – March 13th).
Nick’s Law in the House, HB2459 by Rep. Colby Schwartz is still alive as well. Currently, it awaits a hearing in the House Economic Development Committee. We have until March 6th to have Nick’s Law reported out of this committee..."
http://nickslawok.blogspot.com/2008/02/nicks-law-update-feb-25-2008.html
========================
DEAD in this version 2/21/08 SB 1537/Nick's Law, including but not limited to coverage for behavioral therapy.
Newstory
OK Bill would require insurance to cover autism
Text of Bill; Says 2/4/2008; News says 1/10/08.
Author: Sen. Jay Paul Gumm
Bill SB1537 S INTRODUCED 2/4/2008 Autism insurance coverage
Clause relevant to Behavior analysis
"The insurer shall provide coverage for all therapies, treatments, diagnoses and testing, medicines and supplements prescribed by a licensed physician, including but not limited to coverage for behavioral therapy.
F. Coverage for behavioral therapy shall be subject to a maximum benefit of Seventy-five- Thousand- Dollars ($75,000.00) per year. The maximum period of coverage for behavior therapy shall be three (3) years, unless clinical progress reports demonstrate that the child is in a period of steady skill acquisition. For behavioral therapy to continue beyond three (3) years, the child’s physician and/or licensed behavioral practitioner shall submit progress reports not less than once every six (6) months demonstrating continuing clinically significant progress."
OKLAHOMA SB2071Comprehensive autism training prog-Request UCO to establish
Sponsor: Jolley
AS INTRODUCED
"An Act relating to higher education; requesting the Regional University System of Oklahoma establish a comprehensive autism training program at the University of Central Oklahoma; stating purpose of program; providing for codification; and providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified in the Oklahoma Statutes as Section 3520 of Title 70, unless there is created a duplication in numbering, reads as follows:
The Oklahoma State Legislature requests the Regional University System of Oklahoma to establish a comprehensive autism training program with operations at the University of Central Oklahoma. The comprehensive autism training program should provide statewide leadership in the training of post-graduate and post-baccalaureate behavior therapists to deliver research-based intervention services to children with autistic spectrum disorders. Such program will meet national standards and qualify candidates upon completion of the training program to take the national certification exam.
SECTION 2. This act shall become effective November 1, 2008.
51-2-3497 KM 1/26/2008 6:12:39 PM
PENNSYLVANIA [HB 1150 (Autism Speaks)
Introduced by D. O'Brien,DeWeese,Pallone,Phillips,Rapp,Scavello,Sturla,Baker, Bastian,Boyd,Brooks,Caltagirone,Carroll,et. al. April 30, 2007.
As amended on second consideration, House of Representatives, July 13, 2007
Related:
Accessed January 1, 2008
Related VERMONT S 274 THE CREATION OF PILOT REGIONAL AUTISM CENTERS
Currently in S Health & Welfare 01/08/2008
VIRGINIA HB83 Children; insur. co. to provide coverage for habilitative services.
12/11/07 House: Prefiled and ordered printed; offered 01/09/08 083130616 (impact statement)
Status:
12/11/07 House: Prefiled and ordered printed; offered 01/09/08 083130616
12/11/07 House: Referred to Committee on Commerce and Labor
01/15/08 House: Passed by in Commerce and Labor with letter by voice vote
On January 15, HB83, which would grant health insurance parity to individuals with autism spectrum disorders, was introduced to the Commerce Committee in the Virginia House of Delegates. After hearing testimony, Representatives voted to move it to the Subcommittee on Insurance Mandates for review.More info
Mandated coverage for habilitative services for children. Requires insurance companies to provide coverage for habilitative services for children.
1. That § 38.2-4319 of the Code of Virginia is amended and reenacted and that the Code of Virginia is amended by adding a section numbered 38.2-4318.15 as follows:
§38.2-3418.15. Coverage for habilitative services for children.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident or sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; corporation providing individual or group accident or sickness subscription contracts; and health maintenance organization providing a health care plan for health care services shall provide coverage under any such policy, contract, or plan delivered, issued for delivery, or renewed in the Commonwealth on and after July 1, 2008, for medically necessary habilitative services for persons younger than 19 years.
INTRODUCED BUT STALLED, TABLED OR OTHERWISE AMENDED TO REMOVE ORIGINAL INTENT
HAWAII Was SB2532,HB 2727 including but not limited to coverage for behavioral therapy. now HB 2727 HD1 SD1 appoints task force
WAS HB2727 now HB2727 HD2 SD1
Generated on 3/24/2008 1:14:09 PM
Measure Title:
RELATING TO HEALTH INSURANCE.
Report Title:
Task Force; Health Coverage; Autism Spectrum Disorders
Description:
Establishes the temporary autism disorders spectrum benefits and coverage task force to research the problems faced by parents of children with autism and what can be done to ensure that proper benefits and services are provided through public and private resources to address the special needs of children with autism, including providing services involving applied behavioral analyses techniques. (SD1)
Bill Status
======================================
Hawaii Autism Bill/Dylan's Law Blogspot
HI SB 2532,
deferred 2/8/08
referred 1/22/08 to CPH(Committee on Commerce, Consumer Protection and Affordable Housing)
and
HTH(Committee on Health) committees.
HI SB 2532
Bill status and to subscribe to RSS Feed
Excerpt from bill text:
"..."Medically necessary" means any care, treatment,
intervention, service or item that is prescribed, provided, or ordered by a physician, psychologist, or registered nurse practitioner licensed to practice in this State in accordance with accepted standards or practice and that is reasonably
expected to accomplish any of the following:
...
"Rehabilitative care" means professional, counseling, and guidance services and treatment programs, including APPLIED BEHAVIOR ANALYSIS, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.
DEFERRED Related: Hawaii SB2738 insurance coverage autism; DOES NOT explicitly include ABA and differing definitions rehabilative care.
SB 2738 Deferred 2/1/08.
For differences to SB2532/Dylan's Bill, see explanation at
Action Alert Hawaii Autism Bill/Dylan's Bill blogspot
Introduced 1/22/08 by Senators Chun, Oakland
Currently referred to
CPH(Committee on Commerce, Consumer Protection and Affordable Housing), and
WAM (Ways and Means)
Report Title:
Autism Spectrum Disorders; Insurance Coverage
Description:
Requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for the diagnosis and treatment of autism spectrum disorders for covered individuals less than twenty-one years of age.
THE SENATE
S.B. NO. 2738
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII
A BILL FOR AN ACT
relating to autism spectrum disorders.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:
"§431:10A- Autism spectrum disorder coverage. Each policy of accident and health or sickness insurance providing health care coverage shall provide coverage for the diagnosis and treatment of autism spectrum disorders for covered individuals under the age of twenty-one years..."
DEAD-- MISSISSIPPI -- HB 487 Includes, not limited to ABA
Background Information:
Disposition: DEAD
Deadline: General Bill/Constitutional Amendment
Revenue: No
Vote type required: Majority
Effective date: July 1, 2008
History of Actions:
1 01/30 (H) Referred To Insurance;Appropria tions
2 02/19 (H) DIED IN COMMITTEE
Introduced 1/30/08
Referred to Insurance/Appropriations Committee
Partial Text
Title: AN ACT TO REQUIRE HEALTH INSURANCE COVERAGE, INCLUDING COVERAGE UNDER THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN, FOR AUTISM SPECTRUM DISORDERS; TO DEFINE "AUTISM SPECTRUM DISORDER" AS AN AUTISTIC DISORDER, ASPERGER'S SYNDROME, OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) As used in this act:
(a) "Applied behavior analysis" means the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement and functional analysis of the relations between environment and behavior.
(b) "Autism services provider" means any person, entity or group that provides treatment of autism spectrum disorders...
(...)
(m) "Treatment for autism spectrum disorders" includes the following care prescribed, provided or ordered for an individual diagnosed with one (1) of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:
(i) Habilitative or rehabilitative care;
(ii) Pharmacy care;
(iii) Psychiatric care;
(iv) Psychological care;
(v) Therapeutic care; and
(vi) Any care for individuals with autism spectrum disorders that is determined by the Department of Mental Health, Division of Autism, based upon its review of best practices or evidence-based research that is medically necessary and that is properly promulgated under regulations establishing standards for qualified autism services providers. Once the regulations are promulgated, payment for the treatment of autism spectrum disorders covered under this act shall only be made to autism services providers who meet the standards.
(2) A health insurance policy shall provide coverage for the diagnosis of autism spectrum disorders and the treatment of autism spectrum disorders in individuals under twenty-one (21) years of age. To the extent that the diagnosis of autism spectrum disorders and the treatment of autism spectrum disorders are not already covered by a health insurance policy, coverage under this act shall be included in health insurance policies that are delivered, executed, issued, amended, adjusted or renewed on or after July 1, 2008.
(...)
(6) Coverage under this act for "applied behavior analysis" shall be subject to a maximum benefit of Fifty Thousand Dollars ($50,000.00) per year..."
See also:
Autism Speaks: Autism Insurance Bill Introduced in Mississippi State Legislature
See also:
REPORT: Caring for Mississippi Children and Families
final report, December 2007
MS Department of Mental Health Division of Autism Spectrum Disorders
MS: Panel urges state to reform autism insurance laws
1/30/2008 6:35:06 AM
Daily Journal
BY BOBBY HARRISON
Daily Journal Jackson Bureau
"JACKSON - Many private health insurance policies exclude coverage for behavioral therapy for children with autism.
A task force developed by the 2007 Mississippi Legislature to look at autism and its related issues is asking that the 2008 Legislature change the law to require insurance companies to provide coverage.
...
The insurance reform proposal is among the legislation the task force wants the Legislature to consider this year.
...
The task force also proposes training at the universities and community colleges for people who work with the children, and an additional $2 million for Medicaid to provide behavior therapy for the children. Currently, Medicaid offers only limited services for autistic children.
The census indicates that Mississippi has about 1,000 children who have been "educationally ruled" as autistic, but many experts believe about 4,000 more haven't been diagnosed.
..."
STALLED- WEST VIRGINIA HB4091, HB3086, SB146 Does not explicitly include ABA but allows "experimental" treatments
27 FEB 2008 It appears that HB4091 may have stalled in the finance committee and put under study until the next session of the WV legislature via HCR 72 Resolution
The info that I have is from the fightingautisminwv blog (an
interesting blog of the the process and progress of the bill).
http://fightingautisminwv.blogspot.com/2008/02/my-letter-to-finance-committee. html
======================
To track the status of the WV bill(s)
HB4091, HB3086, SB146
Rodighiero seems to have support for his bill, which is cosponsored by 10 other delegates - Locke Wysong, D-Jefferson; Doug Reynolds, D-Wayne; Bobbie Hatfield, D-Kanawha; Jeff Eldridge, D-Lincoln; David Perry, D-Fayette; Ted Ellis, D-Logan; Clif Moore, D-McDowell; Larry Barker, D-Boone; Tim Miley, D-Harrison; and Melvin Kessler, D-Raleigh.
WV HB4091
Introduced January 18, 2008; referred to the
Committee on Banking and Insurance then Finance.
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-15-22, relating to insurance coverage for autism.
"...(1) Every policy which provides coverage for hospital, surgical, or medical care coverage shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, regardless of whether such prevention, early detection, diagnosis or treatment methods are research based or experimental..."
A similar House bill was introduced earlier this month from Delegates Jeffery Tansill, R-Taylor; Charlene Marshall, D-Monongalia; and Don Perdue, D-Wayne.
WV HB3086
introduced January 9, 2008; referred to the
Committee on Banking and Insurance then the Judiciary.
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-15-22; to amend said code by adding thereto a new section, designated §33-16-18; and to amend said code by adding thereto a new section, designated §33-16D-17, all relating to requiring health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder.
"...Every policy which provides coverage for hospital, surgical, or medical care coverage shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, regardless of whether such prevention, early detection, diagnosis or treatment methods are research based or experimental..."
Even the Senate has its own version of the legislation, which is sponsored by Sens. Jeff Kessler, D-Marshall; and Ed Bowman, D-Hancock.
WV SB146
Introduced January 9, 2008; referred to the Committee on Banking and Insurance; and then to the Committee on Finance.
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-15-22; to amend said code by adding thereto a new section, designated §33-16-18; and to amend said code by adding thereto a new section, designated §33-16D-17, all relating to requiring health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder.
"...Every policy which provides coverage for hospital, surgical, or medical care coverage shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, regardless of whether such prevention, early detection, diagnosis or treatment methods are research based or experimental..."
Update 3/6/08 SB178 in original form tabled by the WI Assembly for this session
Update 3/1/08 SB178 amended to include 1 time diversion of 6 million dollars to reduce wait list, but deletes insurance related clauses. Advocates urging legislators to reinstate original language and intent of the bill.
Vote in Assembly scheduled for 3/5/08. Renumbered as AB 901 (see below) Original version of SB178 (pdf)
=================
ASA1-SB178
LRBs0315/1
PJK&DAK::kjf&bjk::rs
2007 - 2008 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,TO 2007 SENATE BILL 178
February 28, 2008 - Offered by Representatives Newcomer, Petersen, Lothian, Albers, Ballweg, Bies, Davis, J. Fitzgerald, Friske, Gottlieb, Gunderson,
Hahn, Hines, Honadel, Huebsch, Jeskewitz, Kaufert, Kerkman, Kestell,Kleefisch, Kramer, LeMahieu, Meyer, Montgomery, Moulton, Mursau,Murtha, Musser, Nass, Nerison, Nygren, A. Ott, J. Ott, Owens, Petrowski,
Pridemore, Rhoades, Stone, Suder, Tauchen, Townsend, Van Roy, Vukmir, Wieckert, M. Williams, Wood and Zipperer.
An Act to create 51.03 (7) and 146.85 of the statutes; relating to: requiring
development and distribution of a brochure, requiring a treatment plan and
referral when certain diagnoses are made, increasing funding for the Medical
Assistance autism benefit, and making an appropriation.
________________________________________________________________________
Analysis by the Legislative Reference Bureau
ASA1-SB178
This substitute amendment increases a general purpose revenue appropriation to the Department of Health and Family Services (DHFS) by $6,060,000 in fiscal year
2008-09 for the autism benefit under the Medical Assistance (MA) program. Under an MA waiver of federal law, DHFS provides in-home services to children who have been diagnosed with an autism spectrum disorder and who would not otherwise be
eligible for MA benefits. The funding increase under this substitute amendment would be used to provide those services to children diagnosed with an autism
spectrum disorder who are on the statewide waiting list for those services.
ASA1-SB178
The substitute amendment requires a health care provider who diagnoses a patient with a condition, injury, or illness other than alcoholism, drug dependency,mental illness, or developmental disability, that requires further treatment, to
provide the patient (or, if a minor, the patient's parent, guardian, or legal custodian)with a treatment plan and to provide any necessary and appropriate referral for further treatment or services.
ASA1-SB178
In addition, the substitute amendment directs DHFS to develop and periodically update a brochure describing the activities that a parent or guardian of a child with autism may engage in at home with the child to complement the child's treatment or individualized education program. DHFS must distribute the brochure
to local educational agencies and physicians.
________________________________________________________________________
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
ASA1-SB178, s. 1
Section 1. 51.03 (7) of the statutes is created to read:
ASA1-SB178, s. 1 - continued
51.03 (7) The department shall develop and periodically update a brochure
describing the activities that a parent of a child with autism may engage in at home
with the child to complement the child's treatment or individualized education
program, as defined in s. 115.76 (9). In developing the brochure, the department
shall consult with teachers of special education, as defined in s. 115.76 (15); parents
of autistic children; physicians; and representatives of organizations that advocate
for the interests of children with disabilities. The department shall distribute the
brochure to local educational agencies, as defined in s. 115.76 (10), and physicians.
===================
Update 2/26/08. SB178 passed WI Senate vote 25-8. Passes to state Assembly. Must be scheduled for vote before March adjournment to remain a live bill
Introduced by Senators Obson, Wirch, Breske, Coggs, et. al. May 9, 2007
Referred to Committee on Public Health, Senior Issues, Long Term Care and Privacy.
This bill requires health insurance policies and self−insured governmental and school district health plans to cover the cost of treatment for an insured for autism, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified
if the treatment is provided by a psychiatrist, a psychologist, a social worker who is certified or licensed to practice psychotherapy, a paraprofessional working under the supervision of any of those three types of providers, or a professional working under the supervision of an outpatient mental health clinic. Limitations and exceptions defined.
An Act to create 51.03 (7) and 146.85 of the statutes; relating to:
requiring development and distribution of a brochure, requiring a
treatment plan and referral when certain diagnoses are made, increasing
funding for the Medical Assistance autism benefit, and making an
appropriation. (FE)
See:
The California Legislative Blue Ribbon Commission on Autism Report. September 2007. p.27-28
"...significant cost avoidance may be possible with “early intensive behavioral intervention,” a specific type of intervention that uses principles of applied behavior analysis that have demonstrated efficacy with many children with ASD. Another study published in 2006 showed similar conclusions about the likely cost effectiveness of a potential expansion of intensive behavioral services for autistic children in Ontario, Canada..."
States noted from multiple sources as addressing autism either via apecific mandate or Mental Health Parity legislation.
Steven's Law signed into law by Governor Napolitano, 3/22/08.
SB1263/Steven's Law; recommends and defines specific "behavioral therapies"
B 1263/ Steven's Law
Introduced 1/29/08
Senators Aguirre, Allen, Burton Cahill, Hale, Landrum Taylor, McCune Davis, Miranda, O'Halleran, Rios; Representatives Ableser, Lujan, Pancrazi, Sinema, Ulmer: Senators Aboud, Garcia, Soltero; Representatives Cajero Bedford, Chabin, DeSimone, Farley, Hershberger, Lopez, Miranda B, Rios P, Tom
"AN ACT
amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-826.04; amending title 20, chapter 4, ARTICLE 9, Arizona Revised Statutes, by adding section 20-1057.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding sections 20-1402.03 and 20-1404.03; relating to health insurance policies
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-826.04, to read:
20-826.04. Subscription contracts; autism spectrum disorder; coverage; exception; definitions
...Treatment may not be limited or denied on the basis that it is habilitative in nature.
...The benefits and coverage provided pursuant to this section must be provided to any eligible person who is under eighteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year, but may not be subject to any limits on the number of visits an eligible person may make to a provider of behavioral therapy...
"Behavioral therapy" includes interactive therapies derived from evidenced based research, including applied behavior analysis, which is also known as lovaas therapy, discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention. ..
...and is limited to treatment, including speech therapy, occupational therapy, physical therapy, behavioral therapy, psychiatric care and psychological care, that is prescribed by the insured's treating medical doctor pursuant to a treatment plan..."
~AZAutismInsurance BLOG reporting on/tracking this legislation
California law requires health insurers to cover autism services as they would mental illnesses.
(CAL. Health & Safety Code §1374.72) “Every health care service plan contract…that provides
hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically
necessary treatment of severe mental illnesses of a person of any age…For the purposes of this
section, "severe mental illnesses" shall include…pervasive developmental disorder or autism.”
THE LAW OF HMO/PPO SPECIAL NEEDS STATE MANDATES.
Christopher E. Angelo, Attorney at Law.
California Law On Health Care Reimbursement
Christopher E. Angelo, Attorney at Law
Medical Necessity and Assembly Bill 88.
CARD.
(1) Any sickness and accident insurance policy providing indemnity for disability due to sickness issued by an entity subject to the provisions of part 2 of this article and any individual or group service or indemnity contracts issued by an entity subject to the provisions of part 3 or 4 of this article which provide coverage for autism shall provide such coverage in the same manner as for any other accident or sickness, other than mental illness, otherwise covered under such policy.
(2) Nothing in this section shall mandate or be construed or interpreted to mandate that any policy, hospital service or indemnity contract, or evidence of coverage must provide coverage for autism.
History
Source: L. 93: Entire section added, p. 956, § 3, effective May 28.
Annotations
Cross references: For the legislative declaration contained in the act enacting this section, see section 1 of chapter 211, Session Laws of Colorado 1993.
Sec. 38a-514a. Biologically-based mental illness. Coverage required. Section 38a-514a is repealed, effective January 1, 2000.
(P.A. 97-99, S. 27; June 18 Sp. Sess. P.A. 97-8, S. 62, 88; P.A. 99-284, S. 59, 60.)
Connecticut does not have a law specifically mandating coverage of autism. Instead, Connecticut
requires health insurers to cover autism services as they would mental illnesses. (CONN. GEN.
STAT. § 38a-488a and § 38a-514)
05/02/08 SENATE Ordered enrolled -SJ 01719
05/16/08 Signed by Officers and presented to Governor
05/20/08 Approved by Governor; Chapter No. 2008-30
FL SB 2654 and H1291 Insurance, Relating to Autism Spectrum Disorder
02/29/08 HOUSE Filed
02/29/08 SENATE Filed
S2654 GENERAL BILL by Geller (Compare H 1291)
Autism Spectrum Disorder; Cites this act as the "Window of Opportunity Act." Requires health insurance plans to provide coverage for screening, diagnosis, intervention, and treatment of autism spectrum disorder in certain children. Prohibits an insurer from denying or refusing coverage or refusing to renew or reissue or terminate coverage based on a diagnosis of autism spectrum disorder, etc. EFFECTIVE DATE: 01/01/2009.
TEXT
======
H1291 GENERAL BILL by Porth (Compare S 2654)
Autism Spectrum Disorder; Includes autism spectrum disorder within training requirements for personnel of child care facilities; requires health insurance plans to provide coverage for screening, diagnosis, intervention, & treatment of autism spectrum disorder in children; requires treatment plan; prohibits insurers from denying or refusing coverage or refusing to renew or reissue or terminate coverage based on diagnosis of autism spectrum disorder, etc. EFFECTIVE DATE: 01/01/2009.
TEXT
======
"...Senate Democrat Steve Geller of Cooper City. Geller has been trying get autism insurance mandated for years, but he sees more opportunity this spring. It's his final session in a long legislative career.
"I feel really, really strongly about this issue," he said. "I'm going to see if I can persuade some people who might not otherwise vote for it. This is my going-away present."
Geller said he'll likely go for a $10,000 or $12,000 yearly coverage limit for autism treatments — less than what advocates want, but "a lot better than nothing," he said..."
"Insurance coverage for autism is goal of Palm Beach County commissioner"
Josh Hafenbrack, South Florida Sun-Sentinel, December 26, 2007
If a policy includes benefits for neurological disorders, it is prohibited from denying benefits for autism. Such benefits are subject to the same terms and conditions as those for neurological disorders
Georgia law says that if a health insurance policy includes benefits for neurological disorders, it
cannot deny benefits for autism-related services. (GA. CODE ANN. § 33-24-59.10)
Enrolled 6/23/2006; Effective date 1/1/2007
The new law requires all state, local and private insurance plans to pay for treatment of "pervasive developmental disorders" and requires group health benefit plans to provide coverage for 20 additional outpatient visits for speech therapy. As insurance plans got renewed during the next year, the extra coverage would be included in the new policies. 25/06/2006. Autism Connect News
MENTAL HEALTH PARITY (2002) 215 ILCS 5/370(c)
Illinois law requires health insurers to cover autism services as they would mental illnesses.
(ILL. REV. STAT. ch. 73, para. 982c )
Defines “Behavior Analyst” as a person certified by the Behavior Analysis Certification Board; and adds “Behavior Analyst” to that list of persons defined
Policies must include coverage for pervasive developmental disorders, including autism. Coverage may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to an insured than those that apply to physical illness. Insurers and HMOs cannot deny or refuse to issue coverage on, refuse to contract with, refuse to renew or reissue, or otherwise terminate or restrict coverage on an individual because of a pervasive developmental disorder diagnosis
See also:
Indiana's Health Insurance Mandate for Autism Spectrum Disorders (ASDs) and Pervasive Developmental Disorders (PDDs) Indiana law says that health insurance policies must include coverage for pervasive developmental disorders including autism. "Coverage may not be subject to dollar limits, deductibles, co-payments, or coinsurance provisions that are less favorable to an insured than those that apply to physical illness. Insurers and HMOs cannot deny or refuse to issue coverage on, refuse to contract with, refuse to renew or reissue, or otherwise terminate or restrict coverage
on an individual because of a pervasive developmental disorder diagnosis." (IND. CODE § 27-8-14.2)
Iowa law requires health insurers to cover autism services as they would mental illnesses. (IOWA CODE § 225C.28B)
a) Kansas law requires health insurers to cover autism services as they would mental illnesses. (KAN. STAT. ANN. § 40-2,105a)
b) The Kansas Autism Task Force is studying the issue of how to share the burden for autism services by engaging the insurance industry. A preliminary report is due in November 2007 covering the following: best practice recommendations for educating individuals with
autism; strategies to increase the number and availability of qualified service providers to children with autism in all areas of Kansas; health insurance coverage for services related to autism; accessing education resources and funding; public dissemination of information, and the
need for an autism registry.
Coverage for treatment of autism in children -- Limitation --Definitions
Health benefit plans must include coverage, including therapeutic, respite, and rehabilitative care, for the treatment of autism for a child age 2 through 21. Coverage is subject to a maximum benefit of $ 500 a month ($6000/year) for each covered child
As of October 2007: Louisiana law requires health insurers to cover autism services as they would mental illnesses. (LA. REV. STAT. ANN. § 22:669)
IN PROGRESS (Jan. 2008)
IN PROGRESS (Jan. 2008)
Maine law requires health insurers to cover autism services as they would mental illnesses. (ME. REV. STAT. ANN. tit. 24-A, § 2749-C)
Policies must include coverage for habilitative services for children under age 19. “Habilitative services” means services, including occupational, physical, and speech therapies, for the treatment of a child with a congenital or genetic birth defect, including autism, to enhance the child's ability to function. Reimbursement for habilitative services delivered through early intervention or school services is not required .
See also:
Maryland Law Covers Habilitation Services For Children, But You Need To Ask. Alabama ASHA. 11/24/03.
“Maryland’s Autism Waiver:A Practical Guide for Families”.Maryland Disability Law Center.
State of Maryland, Maryland Insurance Administration. MIA/BULLETIN 02-12, May 2002.
Massachusetts requires private insurance to cover early intervention from birth to 3 years old.(MASS. GEN. L. ch. 175, § Section 47C)
INTENSIVE EARLY INTERVENTION BEHAVIOR THERAPY SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS
Subd. 5a. Services for children with autism spectrum disorders. (a) Medical assistance
covers home-based intensive early intervention behavior therapy for children with autism spectrum disorders, effective July 1, 2007. Children with autism spectrum disorder, and their custodial parents or foster parents, may access other covered services to treat autism spectrum disorder, and are not required to receive intensive early intervention behavior therapy services under this subdivision. (cont.-Subd. 5k. )
Mental Health Parity. A health benefit plan shall provide coverage for treatment of a mental health condition and shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a mental health condition than for access to treatment for a physical health condition. Any deductible or out-of-pocket limits required by a health carrier or health benefit plan shall be comprehensive for coverage of all health conditions, whether mental or physical. Definitions. NB-States allowable exclusion of "Experimental" treatments.
Mental Health Parity. Defines autism as a "severe mental illness", effective 1/1/2009. Defines benefits and coverage. A policy or certificate of health insurance or disability insurance that is delivered, issued for delivery, renewed, extended, or modified in this state must provide a level of benefits for the necessary care and treatment of severe mental illness, as defined in statute, that is no less favorable than that level provided for other physical illness generally. Benefits for treatment of severe mental illness may be subject to managed care provisions contained in the policy or certificate.
Montana requires health insurers to cover autism services as they would mental illnesses.
(MONT. CODE ANN. § 33-22-706)
New Hampshire law requires health insurers to cover autism services as they would mental
illnesses. (N.H. REV. STAT. ANN. § 417-E)
New Jersey requires health insurers to cover autism services as they would mental illnesses. (N.J. REV. STAT. § 17:48-6v)
Policies are prohibited from excluding coverage for the diagnosis and treatment of ASD, including autism(N.Y. Ins. Law § 3221(l)(17), effective January 1, 2007).
Bill Summary, state of NY
http://assembly.state.ny.us/leg/?bn=A00539
S784-B FUSCHILLO --
Same as A 699-B Pheffer
SUMM : Amd SS3216, 3221 & 4303, Ins L Relates to health insurance coverage for autism spectrum disorders, provides that coverage for diagnosis and treatment of medical conditions otherwise covered shall not be denied solely because such treatment is provided to diagnose an autism spectrum disorder.
Last Act: 08/16/06 SIGNED INTO LAW AS CHAPTER 557 OF THE LAWS OF 2006
http://www.cqcapd.state.ny.us/counsels_corner/legl06.htm
a) New York provides at least some coverage for autism-related services (e.g. policies are prohibited from excluding coverage for the diagnosis and treatment of ASD, including autism). N.Y. ISC § 3216)
b) In February 2007, a bill was introduced to require health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorders. (2007 N.Y. Bill A00539A]
IN PROGRESS (Jan. 2008)
Recommendations have been made by the Ohio A
TABLED--WISCONSIN 2007 SB 178 - No specific treatment or therapy specified.
Amendment of 2/28/08
Related AB901--renumbered amended version of SB178 provides one year funding and brochure
PROJECTED FOR FUTURE
CALIFORNIA — Bill projected for future (Autism Speaks)
STATUTE ON AUTISM AND HEALTH INSURANCE
LAW ARIZONA - 1/29/08 Introduced Signed into law 3/22/08
CALIFORNIA Coverage under Assembly Bill 88,Cal. Ins. Code §10144.5;Cal.Health&SafetyCode §1374.72
COLORADO CO.Rev.Stat. §10-16-104(1.7)
CONNECTICUT (1999) P.A. 99-284, Sec. 38a-514a.
LAW FLORIDA — SB 2654 and
HB 1291 (Autism Speaks)Passed House and Senate 5/2/08.
GEORGIA: (Ga.Code Ann.§ 33-24-59.10)
ILLINOIS Public Act 94-0906
RELATED: BCBAs in schools (House Bill 4987)Enrolled as Public Act: 094-0948; Effective 1/1/2007
INDIANA: Ind.Code §§ 27-13-7-14.7 and 27-8-14. 2-1 through 27-8-14. 2-5 ABA covered
IOWA: Iowa Code § 225C.28B
KANSAS: Kan. Stat. Ann. § 40-2,105a
KENTUCKY: Ky. Rev. Stat. Ann. § 304.17A-143
LOUISIANA (2000) 22 La.Rev.Stat. §669
MAINE (2003) Me.Rev.Stat. Ti.24-A §2843(5-C)
MARYLAND: Md.Code Ann.[Insurance] § 15-835
MASSACHUSETTS (MASS. GEN. L. ch. 175, § Section 47C)
MINNESOTA (2001)Minnesota Statutes 2001, section 256B.0625, Subd. 5a
MISSOURI 376.1550, RSMo
MONTANA (2001) Mont.Code §33-22-706
NEW HAMPSHIRE (2003) 37 N.H.Rev.Stat.Ann. §417-E:1
NEW JERSEY (N.J. REV. STAT. § 17:48-6v)
NEW YORK: N.Y. Ins. Law § 3221(l)(17)
NORTH CAROLINA
OHIO