Bill Text: FL H1431 | 2011 | Regular Session | Introduced

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Bill Title: Autism

Spectrum: Partisan Bill (Republican 5-0)

Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [H1431 Detail]

Download: Florida-2011-H1431-Introduced.html

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HB 1431

1	A bill to be entitled
2	An act relating to autism; creating s. 381.986, F.S.;
3	requiring that a physician refer a minor to an appropriate
4	specialist for screening for autism spectrum disorder
5	under certain circumstances; defining the term
6	"appropriate specialist"; amending ss. 627.6686 and
7	641.31098, F.S.; defining the term "direct patient
8	access"; requiring that certain insurers and health
9	maintenance organizations provide direct patient access to
10	an appropriate specialist for screening for or evaluation
11	or diagnosis of autism spectrum disorder; requiring
12	certain insurance policies and health maintenance
13	organization contracts to provide a minimum number of
14	visits per year for screening for or evaluation or
15	diagnosis of autism spectrum disorder; providing an
16	effective date.
17
18	Be It Enacted by the Legislature of the State of Florida:
19
20	Section 1.  Section 381.986, Florida Statutes, is created
21	to read:
22	381.986  Screening for autism spectrum disorder.-
23	(1)  If the parent or legal guardian of a minor believes
24	that the minor exhibits symptoms of autism spectrum disorder,
25	the parent or legal guardian may report his or her observation
26	to a physician licensed in this state. The physician shall
27	perform screening in accordance with American Academy of
28	Pediatrics' guidelines. If the physician determines that
29	referral to a specialist is medically necessary, the physician
30	shall refer the minor to an appropriate specialist to determine
31	whether the minor meets diagnostic criteria for autism spectrum
32	disorder. If the physician determines that referral to a
33	specialist is not medically necessary, the physician shall
34	inform the parent or legal guardian of the option for the parent
35	or guardian to refer the child to the Early Steps Program or
36	other specialist in autism. This section does not apply to a
37	physician providing care under s. 395.1041.
38	(2)  As used in this section, the term "appropriate
39	specialist" means a qualified professional licensed in this
40	state who is experienced in the evaluation of autism spectrum
41	disorder and has training in validated diagnostic tools. The
42	term includes, but is not limited to:
43	(a)  A psychologist;
44	(b)  A psychiatrist;
45	(c)  A neurologist;
46	(d)  A developmental or behavioral pediatrician; or
47	(e)  A professional whose licensure is deemed appropriate
48	by the Children's Medical Services Early Steps Program within
49	the Department of Health.
50	Section 2.  Section 627.6686, Florida Statutes, is amended
51	to read:
52	627.6686  Coverage for individuals with autism spectrum
53	disorder required; exception.-
54	(1)  This section and s. 641.31098 may be cited as the
55	"Steven A. Geller Autism Coverage Act."
56	(2)  As used in this section, the term:
57	(a)  "Applied behavior analysis" means the design,
58	implementation, and evaluation of environmental modifications,
59	using behavioral stimuli and consequences, to produce socially
60	significant improvement in human behavior, including, but not
61	limited to, the use of direct observation, measurement, and
62	functional analysis of the relations between environment and
63	behavior.
64	(b)  "Autism spectrum disorder" means any of the following
65	disorders as defined in the most recent edition of the
66	Diagnostic and Statistical Manual of Mental Disorders of the
67	American Psychiatric Association:
68	1.  Autistic disorder.
69	2.  Asperger's syndrome.
70	3.  Pervasive developmental disorder not otherwise
71	specified.
72	(c)  "Direct patient access" means the ability of an
73	insured to obtain services from an in-network provider without a
74	referral or other authorization before receiving services.
75	(d)(c)  "Eligible individual" means an individual under 18
76	years of age or an individual 18 years of age or older who is in
77	high school and who has been diagnosed as having a developmental
78	disability at 8 years of age or younger.
79	(e)(d)  "Health insurance plan" means a group health
80	insurance policy or group health benefit plan offered by an
81	insurer which includes the state group insurance program
82	provided under s. 110.123. The term does not include a any
83	health insurance plan offered in the individual market, a any
84	health insurance plan that is individually underwritten, or a
85	any health insurance plan provided to a small employer.
86	(f)(e)  "Insurer" means an insurer providing health
87	insurance coverage, which is licensed to engage in the business
88	of insurance in this state and is subject to insurance
89	regulation.
90	(3)  A health insurance plan issued or renewed on or after
91	April 1, 2009, shall provide coverage to an eligible individual
92	for:
93	(a)  Direct patient access to an appropriate specialist, as
94	defined in s. 381.986, for a minimum of three visits per policy
95	year for screening for or evaluation or diagnosis of autism
96	spectrum disorder.
97	(b)(a)  Well-baby and well-child screening for diagnosing
98	the presence of autism spectrum disorder.
99	(c)(b)  Treatment of autism spectrum disorder through
100	speech therapy, occupational therapy, physical therapy, and
101	applied behavior analysis. Applied behavior analysis services
102	shall be provided by an individual certified pursuant to s.
103	393.17 or an individual licensed under chapter 490 or chapter
104	491.
105	(4)  The coverage required pursuant to subsection (3) is
106	subject to the following requirements:
107	(a)  Coverage shall be limited to treatment that is
108	prescribed by the insured's treating physician in accordance
109	with a treatment plan.
110	(b)  Coverage for the services described in subsection (3)
111	shall be limited to $36,000 annually and may not exceed $200,000
112	in total lifetime benefits.
113	(c)  Coverage may not be denied on the basis that provided
114	services are habilitative in nature.
115	(d)  Coverage may be subject to other general exclusions
116	and limitations of the insurer's policy or plan, including, but
117	not limited to, coordination of benefits, participating provider
118	requirements, restrictions on services provided by family or
119	household members, and utilization review of health care
120	services, including the review of medical necessity, case
121	management, and other managed care provisions.
122	(5)  The coverage required pursuant to subsection (3) may
123	not be subject to dollar limits, deductibles, or coinsurance
124	provisions that are less favorable to an insured than the dollar
125	limits, deductibles, or coinsurance provisions that apply to
126	physical illnesses that are generally covered under the health
127	insurance plan, except as otherwise provided in subsection (4).
128	(6)  An insurer may not deny or refuse to issue coverage
129	for medically necessary services, refuse to contract with, or
130	refuse to renew or reissue or otherwise terminate or restrict
131	coverage for an individual because the individual is diagnosed
132	as having a developmental disability.
133	(7)  The treatment plan required pursuant to subsection (4)
134	shall include all elements necessary for the health insurance
135	plan to appropriately pay claims. These elements include, but
136	are not limited to, a diagnosis, the proposed treatment by type,
137	the frequency and duration of treatment, the anticipated
138	outcomes stated as goals, the frequency with which the treatment
139	plan will be updated, and the signature of the treating
140	physician.
141	(8)  Beginning January 1, 2011, the maximum benefit under
142	paragraph (4)(b) shall be adjusted annually on January 1 of each
143	calendar year to reflect any change from the previous year in
144	the medical component of the then current Consumer Price Index
145	for all urban consumers, published by the Bureau of Labor
146	Statistics of the United States Department of Labor.
147	(9)  This section may not be construed as limiting benefits
148	and coverage otherwise available to an insured under a health
149	insurance plan.
150	(10)  The Office of Insurance Regulation may not enforce
151	this section against an insurer that is a signatory no later
152	than April 1, 2009, to the developmental disabilities compact
153	established under s. 624.916. The Office of Insurance Regulation
154	shall enforce this section against an insurer that is a
155	signatory to the compact established under s. 624.916 if the
156	insurer has not complied with the terms of the compact for all
157	health insurance plans by April 1, 2010.
158	Section 3.  Section 641.31098, Florida Statutes, is amended
159	to read:
160	641.31098  Coverage for individuals with developmental
161	disabilities.-
162	(1)  This section and s. 627.6686 may be cited as the
163	"Steven A. Geller Autism Coverage Act."
164	(2)  As used in this section, the term:
165	(a)  "Applied behavior analysis" means the design,
166	implementation, and evaluation of environmental modifications,
167	using behavioral stimuli and consequences, to produce socially
168	significant improvement in human behavior, including, but not
169	limited to, the use of direct observation, measurement, and
170	functional analysis of the relations between environment and
171	behavior.
172	(b)  "Autism spectrum disorder" means any of the following
173	disorders as defined in the most recent edition of the
174	Diagnostic and Statistical Manual of Mental Disorders of the
175	American Psychiatric Association:
176	1.  Autistic disorder.
177	2.  Asperger's syndrome.
178	3.  Pervasive developmental disorder not otherwise
179	specified.
180	(c)  "Direct patient access" means the ability of an
181	insured to obtain services from an in-network provider without a
182	referral or other authorization before receiving services.
183	(d)(c)  "Eligible individual" means an individual under 18
184	years of age or an individual 18 years of age or older who is in
185	high school and who has been diagnosed as having a developmental
186	disability at 8 years of age or younger.
187	(e)(d)  "Health maintenance contract" means a group health
188	maintenance contract offered by a health maintenance
189	organization. The This term does not include a health
190	maintenance contract offered in the individual market, a health
191	maintenance contract that is individually underwritten, or a
192	health maintenance contract provided to a small employer.
193	(3)  A health maintenance contract issued or renewed on or
194	after April 1, 2009, shall provide coverage to an eligible
195	individual for:
196	(a)  Direct patient access to an appropriate specialist, as
197	defined in s. 381.986, for a minimum of three visits per policy
198	year for screening for or evaluation or diagnosis of autism
199	spectrum disorder.
200	(b)(a)  Well-baby and well-child screening for diagnosing
201	the presence of autism spectrum disorder.
202	(c)(b)  Treatment of autism spectrum disorder through
203	speech therapy, occupational therapy, physical therapy, and
204	applied behavior analysis services. Applied behavior analysis
205	services shall be provided by an individual certified pursuant
206	to s. 393.17 or an individual licensed under chapter 490 or
207	chapter 491.
208	(4)  The coverage required pursuant to subsection (3) is
209	subject to the following requirements:
210	(a)  Coverage shall be limited to treatment that is
211	prescribed by the subscriber's treating physician in accordance
212	with a treatment plan.
213	(b)  Coverage for the services described in subsection (3)
214	shall be limited to $36,000 annually and may not exceed $200,000
215	in total benefits.
216	(c)  Coverage may not be denied on the basis that provided
217	services are habilitative in nature.
218	(d)  Coverage may be subject to general exclusions and
219	limitations of the subscriber's contract, including, but not
220	limited to, coordination of benefits, participating provider
221	requirements, and utilization review of health care services,
222	including the review of medical necessity, case management, and
223	other managed care provisions.
224	(5)  The coverage required pursuant to subsection (3) may
225	not be subject to dollar limits, deductibles, or coinsurance
226	provisions that are less favorable to a subscriber than the
227	dollar limits, deductibles, or coinsurance provisions that apply
228	to physical illnesses that are generally covered under the
229	subscriber's contract, except as otherwise provided in
230	subsection (3).
231	(6)  A health maintenance organization may not deny or
232	refuse to issue coverage for medically necessary services,
233	refuse to contract with, or refuse to renew or reissue or
234	otherwise terminate or restrict coverage for an individual
235	solely because the individual is diagnosed as having a
236	developmental disability.
237	(7)  The treatment plan required pursuant to subsection (4)
238	shall include, but is not limited to, a diagnosis, the proposed
239	treatment by type, the frequency and duration of treatment, the
240	anticipated outcomes stated as goals, the frequency with which
241	the treatment plan will be updated, and the signature of the
242	treating physician.
243	(8)  Beginning January 1, 2011, the maximum benefit under
244	paragraph (4)(b) shall be adjusted annually on January 1 of each
245	calendar year to reflect any change from the previous year in
246	the medical component of the then current Consumer Price Index
247	for all urban consumers, published by the Bureau of Labor
248	Statistics of the United States Department of Labor.
249	(9)  The Office of Insurance Regulation may not enforce
250	this section against a health maintenance organization that is a
251	signatory no later than April 1, 2009, to the developmental
252	disabilities compact established under s. 624.916. The Office of
253	Insurance Regulation shall enforce this section against a health
254	maintenance organization that is a signatory to the compact
255	established under s. 624.916 if the health maintenance
256	organization has not complied with the terms of the compact for
257	all health maintenance contracts by April 1, 2010.
258	Section 4.  This act shall take effect July 1, 2011.

CODING: Words stricken are deletions; words underlined are additions.