09 AM
37 0067
Senator
Grant of the 25th offered the following amendment:
Amend
the Senate Insurance Committee substitute to SB 161 by inserting
after "definitions;"
on line 3 the
following:
to provide for an effective date;
to provide for an effective date;
By
adding at the end of line 24 the
following:
Accident and sickness contract, policy, or benefit plan shall not include any health plan provided pursuant to Chapter 29 of this title.
Accident and sickness contract, policy, or benefit plan shall not include any health plan provided pursuant to Chapter 29 of this title.
By
striking lines 25 through line 74 and inserting in lieu thereof the
following:
(2)
'Autism
spectrum
disorder' means a
developmental,
neurological
medical
disorder,
usually appearing in the first three years of life, which affects normal brain
functions and is manifested by compulsive, ritualistic behavior and severely
impaired social interaction and communication
skills
and shall
include and be limited to one of the three following disorders:
(A)
Asperger's syndrome;
(B)
Autistic disorder; or
(C)
Pervasive developmental disorder — not otherwise
specified.
(3)
'Behavioral therapy' means discrete trial training, pivotal response training,
verbal behavior intervention, and early intensive behavioral
intervention.
(4)
'Treatment plan' means an individualized, written document based on a
comprehensive evaluation made pursuant to the recommendation of the American
Academy of Pediatrics.
By
striking lines 82 through 107 and inserting in lieu thereof the
following:
other
diagnosed neurological disorder.
Any accident
and sickness contract, policy, or benefit plan shall provide coverage for the
treatment of an autism spectrum disorder. Coverage provided under this Code
section shall be limited to treatment that is prescribed by an insured's
treating physician, as defined in paragraph (2.1) of Code Section 43-34-20, in
accordance with a treatment plan. Coverage shall be provided for behavioral
therapy, speech therapy, occupational therapy, and physical therapy when such
therapies are prescribed in accordance with the treatment plan. No insurer
shall deny or refuse to issue coverage on, refuse to contract with, refuse to
renew or refuse to reissue, or otherwise terminate or restrict coverage on an
individual solely because the individual is diagnosed with an autism spectrum
disorder.
(c)
The coverage required pursuant to subsection (b) of this Code section shall not
be subject to dollar limits, deductibles, or coinsurance provisions that are
less favorable to an insured than the dollar limits, deductibles, or coinsurance
provisions that apply to medical benefits generally under an accident and
sickness contract, policy, or benefit plan, except as otherwise provided for in
subsection (e) of this Code section; provided, however, that the coverage
required pursuant to subsection (b) of this Code section may be subject to other
general exclusions and limitations of the accident and sickness contract,
policy, or benefit plan, including, but not limited to, coordination of
benefits, participating provider requirements, restrictions on services provided
by family or household members, utilization review of health care services
including review of medical necessity, case management, and other managed care
provisions. For purposes of this Code section, behavioral therapy shall be
considered to be a medical benefit as opposed to a mental health benefit. Any
entity subject to this Code section is not required to provide reimbursement for
any services under early intervention, state, or school programs, including but
not limited to an individualized family service plan, an individualized
education program, or an individualized service plan.
(d)
The treatment plan required pursuant to subsection (b) of this Code section
shall include all elements necessary for appropriate claims
payment.
By
striking lines 108 through 125 and inserting in lieu thereof the
following:
(e)
Coverage for behavioral therapy under this Code section may be subject to a
maximum benefit of $36,000.00 per year and a maximum benefit of
$200,000.00.
(f)
To be eligible for benefits and coverages under this Code section, an individual
shall be diagnosed with autistic spectrum disorder at age eight or younger. The
benefits and coverage provided pursuant to this Code section shall be provided
to any eligible person under 16 years of age.
By
striking
"(i)"
from line 126
and
"25"
from line 127 and
inserting in lieu thereof
"(g)"
and
"50",
respectively.
By
inserting between lines 128 and 129 the
following:
This Act shall be effective for policies issued on or renewed after January 1, 2010.
This Act shall be effective for policies issued on or renewed after January 1, 2010.
SECTION
4.