Bill Text: FL S0214 | 2010 | Regular Session | Comm Sub
Bill Title: Autism and Other Developmental Disabilities [SPSC]
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Failed) 2010-04-30 - Died in Committee on Policy & Steering Committee on Ways and Means [S0214 Detail]
Download: Florida-2010-S0214-Comm_Sub.html
Florida Senate - 2010 CS for CS for CS for SB 214 By the Committees on Governmental Oversight and Accountability; Banking and Insurance; and Health Regulation; and Senators Ring, Gardiner, and Fasano 585-04285-10 2010214c3 1 A bill to be entitled 2 An act relating to autism and other developmental 3 disabilities; creating s. 381.986, F.S.; requiring 4 that a physician refer a minor to an appropriate 5 specialist for screening for autism spectrum disorder 6 under certain circumstances; defining the term 7 “appropriate specialist”; amending ss. 627.6686 and 8 641.31098, F.S.; defining the terms “developmental 9 disability” and “direct patient access”; providing 10 health insurance coverage for individuals with certain 11 developmental disabilities; requiring certain insurers 12 and health maintenance organizations to provide direct 13 patient access to an appropriate specialist for the 14 screening, evaluation, or diagnosis of autism spectrum 15 disorder or other developmental disabilities; 16 requiring the insurer’s policy or the health 17 maintenance organization’s contract to provide a 18 minimum number of visits per year for the screening, 19 evaluation, or diagnosis of autism spectrum disorder 20 or other developmental disabilities; revising the 21 effective dates of certain enforcement provisions; 22 providing a declaration of important state interest; 23 providing applicability; providing an effective date. 24 25 Be It Enacted by the Legislature of the State of Florida: 26 27 Section 1. Section 381.986, Florida Statutes, is created to 28 read: 29 381.986 Screening for autism spectrum disorder.— 30 (1) If the parent or legal guardian of a minor believes 31 that the minor exhibits symptoms of autism spectrum disorder as 32 defined in ss. 627.6686 and 641.31098, the parent or legal 33 guardian may report his or her observation to a physician 34 licensed in this state. The physician shall perform screening in 35 accordance with American Academy of Pediatrics’ guidelines. If 36 the physician determines that referral to a specialist is 37 medically necessary, he or she shall refer the minor to an 38 appropriate specialist to determine whether the minor meets 39 diagnostic criteria for autism spectrum disorder as defined in 40 ss. 627.6686 and 641.31098. If the physician determines that 41 referral to a specialist is not medically necessary, the 42 physician shall inform the parent or legal guardian that they 43 can self-refer to the Early Steps intervention program or other 44 specialist in autism. This section does not apply to a physician 45 providing care under s. 395.1041. 46 (2) As used in this section, the term “appropriate 47 specialist” means a qualified professional who is experienced in 48 the evaluation of autism spectrum disorder as defined in ss. 49 627.6686 and 641.31098, is licensed in this state, and has 50 training in validated diagnostic tools. The term includes, but 51 is not limited to: 52 (a) A psychologist; 53 (b) A psychiatrist; 54 (c) A neurologist; 55 (d) A developmental or behavioral pediatrician; or 56 (e) A professional whose licensure, by rule, is deemed 57 appropriate by the Children’s Medical Services Early Steps 58 Program within the Department of Health. 59 Section 2. Section 627.6686, Florida Statutes, is amended 60 to read: 61 627.6686 Coverage for individuals with developmental 62 disabilitiesautism spectrum disorder required; exception.— 63 (1) This section and s. 641.31098 may be cited as the 64 “Steven A. Geller Autism Coverage Act.” 65 (2) As used in this section, the term: 66 (a) “Applied behavior analysis” means the design, 67 implementation, and evaluation of environmental modifications, 68 using behavioral stimuli and consequences, to produce socially 69 significant improvement in human behavior, including, but not 70 limited to, the use of direct observation, measurement, and 71 functional analysis of the relations between environment and 72 behavior. 73 (b) “Autism spectrum disorder” means any of the following 74 disorders as defined in the most recent edition of the 75 Diagnostic and Statistical Manual of Mental Disorders of the 76 American Psychiatric Association: 77 1. Autistic disorder. 78 2. Asperger’s syndrome. 79 3. Pervasive developmental disorder not otherwise 80 specified. 81 (c) “Developmental disability” means a disorder or syndrome 82 attributable to cerebral palsy or Down syndrome, which manifests 83 before the age of 18 years and constitutes a substantial 84 handicap that can reasonably be expected to continue 85 indefinitely. As used in this section: 86 1. “Cerebral palsy” has the same meaning as in s. 393.063. 87 2. “Down syndrome” means a disorder caused by the presence 88 of an extra chromosome 21. 89 (d) “Direct patient access” means the ability of an insured 90 to obtain services from an in-network provider without a 91 referral or other authorization before receiving services. 92 (e)(c)“Eligible individual” means an individual under 18 93 years of age or an individual 18 years of age or older who is in 94 high school and who has been diagnosed as having a developmental 95 disability at 8 years of age or younger. 96 (f)(d)“Health insurance plan” means a group health 97 insurance policy or group health benefit plan offered by an 98 insurer which includes the state group insurance program 99 provided under s. 110.123. The term does not include aany100 health insurance plan offered in the individual market, aany101 health insurance plan that is individually underwritten, or a 102anyhealth insurance plan provided to a small employer. 103 (g)(e)“Insurer” means an insurer providing health 104 insurance coverage, which is licensed to engage in the business 105 of insurance in this state and is subject to insurance 106 regulation. 107 (3) A health insurance plan mustissued or renewed on or108after April 1, 2009, shallprovide coverage to an eligible 109 individual for: 110 (a) Direct patient access to one appropriate specialist, as 111 defined in s. 381.986, for a minimum of three visits per policy 112 year for the screening for, evaluation of, or diagnosis of 113 autism spectrum disorder or other developmental disability. 114 (b)(a)Well-baby and well-child screening for diagnosing 115 the presence of autism spectrum disorder. 116 (c)(b)Treatment of autism spectrum disorder or other 117 developmental disability through speech therapy, occupational 118 therapy, physical therapy, and applied behavior analysis. 119 Applied behavior analysis services shall be provided by an 120 individual certified pursuant to s. 393.17 or an individual 121 licensed under chapter 490 or chapter 491. 122 (4) The coverage required pursuant to subsection (3) is 123 subject to the following requirements: 124 (a) Coverage shall be limited to treatment that is 125 prescribed by the insured’s treating physician in accordance 126 with a treatment plan. 127 (b) Coverage for the services described in subsection (3) 128 shall be limited to $36,000 annually and may not exceed $200,000 129 in total lifetime benefits. 130 (c) Coverage may not be denied on the basis that provided 131 services are habilitative in nature. 132 (d) Coverage may be subject to other general exclusions and 133 limitations of the insurer’s policy or plan, including, but not 134 limited to, coordination of benefits, participating provider 135 requirements, restrictions on services provided by family or 136 household members, and utilization review of health care 137 services, including the review of medical necessity, case 138 management, and other managed care provisions. 139 (5) The coverage required pursuant to subsection (3) may 140 not be subject to dollar limits, deductibles, or coinsurance 141 provisions that are less favorable to an insured than the dollar 142 limits, deductibles, or coinsurance provisions that apply to 143 physical illnesses that are generally covered under the health 144 insurance plan, except as otherwise provided in subsection (4). 145 (6) An insurer may not deny or refuse to issue coverage for 146 medically necessary services, refuse to contract with, or refuse 147 to renew or reissue or otherwise terminate or restrict coverage 148 for an individual because the individual is diagnosed as having 149 a developmental disability. 150 (7) The treatment plan required pursuant to subsection (4) 151 shall include all elements necessary for the health insurance 152 plan to appropriately pay claims. These elements include, but 153 are not limited to, a diagnosis, the proposed treatment by type, 154 the frequency and duration of treatment, the anticipated 155 outcomes stated as goals, the frequency with which the treatment 156 plan will be updated, and the signature of the treating 157 physician. 158 (8) Beginning January 1, 2011, the maximum benefit under 159 paragraph (4)(b) shall be adjusted annually on January 1 of each 160 calendar year to reflect any change from the previous year in 161 the medical component of the then current Consumer Price Index 162 for all urban consumers, published by the Bureau of Labor 163 Statistics of the United States Department of Labor. 164 (9) This section may not be construed as limiting benefits 165 and coverage otherwise available to an insured under a health 166 insurance plan. 167 (10) The Office of Insurance Regulation may not enforce 168 this section against an insurer that becomesisa signatoryno169later than April 1, 2009,to the developmental disabilities 170 compact established under s. 624.916 by July 1, 2010. The Office 171 of Insurance Regulation shall enforce this section against an 172 insurer that is a signatory to the compact established under s. 173 624.916 if the insurer has not complied with the terms of the 174 compact for all health insurance plans by April 1, 2010. 175 However, any provisions of this section which are amended 176 effective July 1, 2010, may not be enforced retroactively. 177 Section 3. Subsections (2) and (3) of section 641.31098, 178 Florida Statutes, are amended to read: 179 641.31098 Coverage for individuals with developmental 180 disabilities.— 181 (2) As used in this section, the term: 182 (a) “Applied behavior analysis” means the design, 183 implementation, and evaluation of environmental modifications, 184 using behavioral stimuli and consequences, to produce socially 185 significant improvement in human behavior, including, but not 186 limited to, the use of direct observation, measurement, and 187 functional analysis of the relations between environment and 188 behavior. 189 (b) “Autism spectrum disorder” means any of the following 190 disorders as defined in the most recent edition of the 191 Diagnostic and Statistical Manual of Mental Disorders of the 192 American Psychiatric Association: 193 1. Autistic disorder. 194 2. Asperger’s syndrome. 195 3. Pervasive developmental disorder not otherwise 196 specified. 197 (c) “Developmental disability” means a disorder or syndrome 198 attributable to cerebral palsy or Down syndrome, which manifests 199 before the age of 18 years and constitutes a substantial 200 handicap that can reasonably be expected to continue 201 indefinitely. As used in this section: 202 1. “Cerebral palsy” has the same meaning as in s. 393.063. 203 2. “Down syndrome” means a disorder caused by the presence 204 of an extra chromosome 21. 205 (d) “Direct patient access” means the ability of an insured 206 to obtain services from an in-network provider without a 207 referral or other authorization before receiving services. 208 (e)(c)“Eligible individual” means an individual under 18 209 years of age or an individual 18 years of age or older who is in 210 high school and who has been diagnosed as having a developmental 211 disability at 8 years of age or younger. 212 (f)(d)“Health maintenance contract” means a group health 213 maintenance contract offered by a health maintenance 214 organization. TheThisterm does not include a health 215 maintenance contract offered in the individual market, a health 216 maintenance contract that is individually underwritten, or a 217 health maintenance contract provided to a small employer. 218 (3) A health maintenance contract mustissued or renewed on219or after April 1, 2009, shallprovide coverage to an eligible 220 individual for: 221 (a) Direct patient access to one appropriate specialist, as 222 defined in s. 381.986, for a minimum of three visits per policy 223 year for the screening for, evaluation of, or diagnosis of 224 autism spectrum disorder or other developmental disability. 225 (b)(a)Well-baby and well-child screening for diagnosing 226 the presence of autism spectrum disorder. 227 (c)(b)Treatment of autism spectrum disorder or other 228 developmental disability through speech therapy, occupational 229 therapy, physical therapy, and applied behavior analysis 230 services. Applied behavior analysis services shall be provided 231 by an individual certified pursuant to s. 393.17 or an 232 individual licensed under chapter 490 or chapter 491. 233 Section 4. The Legislature finds that the provision of 234 accessible and affordable quality health care permits all people 235 to lead productive and meaningful lives, and, to this end, it 236 further finds that this act fulfills an important state 237 interest. 238 Section 5. This act shall take effect July 1, 2010, and 239 applies to policies issued or renewed on or after that date.
