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THE SENATE |
S.B. NO. |
2578 |
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TWENTY-SEVENTH LEGISLATURE, 2014 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to health.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that appropriate screening can determine whether an individual as young as one year old is at risk for autism and demonstrates that early treatment improves outcomes. Autism Speaks, an autism science and advocacy organization, estimates that one out of every eighty-eight children is diagnosed with some form of autism. Autism Speaks stresses the importance of recognizing the early signs of autism and seeking early intervention services.
The legislature further finds that the federal Affordable Care Act has improved the availability of screening, diagnosis, and treatment of autism. For example, habilitative services would permit individuals with autism to access ongoing services in speech, occupational, and physical therapy when their physician prescribes it. However, behavioral health treatments such as applied behavior analysis specific to the treatment of autism have not been covered as habilitative services.
The purpose of this Act is to require health insurance to provide coverage for behavioral health treatment of autism spectrum disorders when it is prescribed by an individual's physician and provided by trained professionals, at the time it will most benefit the individual. This treatment shall be covered by health insurance up to the age of six when the individual with autism may receive services as required by federal law from the department of education.
SECTION 2. 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 disorders; benefits and coverage. (a) Each individual or group accident and health or sickness insurance policy, contract, plan, or agreement issued or renewed in this State after December 31, 2015, shall provide to insureds under six years of age diagnosed with an autism spectrum disorder coverage for treatment of autism spectrum disorders.
(b) Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of an accident and health or sickness insurance policy that are no less favorable than the copayment, deductible, and coinsurance provisions for other medical services covered by the policy.
(c) This section shall not be construed as reducing any obligation of the State to provide services to an individual under an individualized family service plan, individualized education program, or individualized service plan.
(d) As used in this section:
"Applied behavior analysis" means the evidence-based 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.
"Autism spectrum disorders" means autism spectrum disorders as defined by the most recent edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM).
"Behavioral health treatment" means treatment programs, including applied behavior analysis, that are:
(1) Medically necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual; and
(2) Provided by a board-certified behavior analyst, licensed psychologist, or individual otherwise qualified to be a board-certified behavior analyst, or licensed psychologist who is engaging in the practicum required for certification or licensure, under the supervision of a board-certified behavior analyst or by a licensed psychologist; provided that all providers of services shall demonstrate they meet the same criminal history record and background check standard as required by the department of human services Med-QUEST division.
"Diagnose" means to determine, through medically necessary assessments, evaluations, or tests, that an individual has an autism spectrum disorder.
"Treatment of autism spectrum disorders" includes behavioral health treatment and habilitative services, as defined by the State for the benchmark benefit package in the health insurance exchange, that are prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician, psychiatrist, psychologist, or registered nurse practitioner if the care is determined to be medically necessary."
SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:
"§432:1- Autism spectrum disorders; benefits and coverage. (a) Each individual or group hospital and medical service corporation contract issued or renewed in this State after December 31, 2015, shall provide to insureds under six years of age diagnosed with an autism spectrum disorder coverage for treatment of autism spectrum disorders.
(b) Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of an accident and health or sickness insurance policy that are no less favorable than the copayment, deductible, and coinsurance provisions for other medical services covered by the policy.
(c) This section shall not be construed as reducing any obligation of the State to provide services to an individual under an individualized family service plan, individualized education program, or individualized service plan.
(d) As used in this section:
"Applied behavior analysis" means the evidence-based 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.
"Autism spectrum disorders" means autism spectrum disorders as defined by the most recent edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM).
"Behavioral health treatment" means treatment programs, including applied behavior analysis, that are:
(1) Medically necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual; and
(2) Provided by a board-certified behavior analyst, licensed psychologist, or individual otherwise qualified to be a board-certified behavior analyst, or licensed psychologist who is engaging in the practicum required for certification or licensure, under the supervision of a board-certified behavior analyst or by a licensed psychologist; provided that all providers of services shall demonstrate they meet the same criminal history record and background check standard as required by the department of human services Med-QUEST division.
"Diagnose" means to determine, through medically necessary assessments, evaluations, or tests, that an individual has an autism spectrum disorder.
"Treatment of autism spectrum disorders" includes behavioral health treatment and habilitative services, as defined by the State for the benchmark benefit package in the health insurance exchange, that are prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician, psychiatrist, psychologist, or registered nurse practitioner if the care is determined to be medically necessary."
SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
"§432D-23 Required
provisions and benefits. Notwithstanding any provision of law to the
contrary, each policy, contract, plan, or agreement issued in the State after
January 1, 1995, by health maintenance organizations pursuant to this chapter,
shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5,
431:10A-116, 431:10A-116.2, 431:10A‑116.5, 431:10A-116.6, 431:10A-119,
431:10A-120, 431:10A‑121, 431:10A-122, 431:10A-125, 431:10A-126, [431:10A-122,
and 431-10A-116.2] and 431:10A- , and chapter
431M."
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Health; Insurance; Mandatory Health Coverage; Behavioral Health Treatment; Autism Spectrum Disorders
Description:
Requires health insurers, mutual benefit societies, and health maintenance organizations to provide coverage for treatment of autism spectrum disorders.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.