Bill Text: FL S0214 | 2010 | Regular Session | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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

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Florida Senate - 2010                              CS for SB 214 
 
By the Committee on Health Regulation; and Senator Ring 
588-02715A-10                                          2010214c1 
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 
4         appropriate specialist for screening for autism 
5         spectrum disorder under certain circumstances; 
6         defining the term “appropriate specialist”; amending 
7         ss. 627.6686 and 641.31098, F.S.; defining the terms 
8         “developmental disability” and “direct patient 
9         access”; providing health insurance coverage for 
10         individuals with certain developmental disabilities; 
11         requiring certain insurers and health maintenance 
12         organizations to provide direct patient access to an 
13         appropriate specialist for screening, evaluation of, 
14         or diagnosis for autism spectrum disorder or other 
15         developmental disabilities; requiring the insurer’s 
16         policy or the health maintenance organization’s 
17         contract to provide a minimum number of visits per 
18         year for the screening, evaluation, or diagnosis for 
19         autism spectrum disorder or other developmental 
20         disabilities; providing an effective date. 
21 
22  Be It Enacted by the Legislature of the State of Florida: 
23 
24         Section 1. Section 381.986, Florida Statutes, is created to 
25  read: 
26         381.986 Screening for autism spectrum disorder.— 
27         (1) If the parent or legal guardian of a minor believes 
28  that the minor exhibits symptoms of autism spectrum disorder, 
29  the parent or legal guardian may report his or her observation 
30  to a physician licensed in this state. The physician shall 
31  perform screening in accordance with American Academy of 
32  Pediatrics’ guidelines. If the physician determines that 
33  referral to a specialist is medically necessary, he or she shall 
34  refer the minor to an appropriate specialist to determine 
35  whether the minor meets diagnostic criteria for autism spectrum 
36  disorder. If the physician determines that referral to a 
37  specialist is not medically necessary, the physician shall 
38  inform the parent or legal guardian that they can self-refer to 
39  the Early Steps intervention program or other specialist in 
40  autism. This section does not apply to a physician providing 
41  care under s. 395.1041. 
42         (2) As used in this section, the term “appropriate 
43  specialist” means a qualified professional who is experienced in 
44  the evaluation of autism spectrum disorder, is licensed in this 
45  state, and has training in validated diagnostic tools. The term 
46  includes, but is not limited to: 
47         (a) A psychologist; 
48         (b) A psychiatrist; 
49         (c) A neurologist; 
50         (d) A developmental or behavioral pediatrician; or 
51         (e) A professional whose licensure is deemed appropriate by 
52  the Children’s Medical Services Early Steps Program within the 
53  Department of Health. 
54         Section 2. Section 627.6686, Florida Statutes, is amended 
55  to read: 
56         627.6686 Coverage for individuals with developmental 
57  disabilities autism spectrum disorder required; exception.— 
58         (1) This section and s. 641.31098 may be cited as the 
59  “Steven A. Geller Autism Coverage Act.” 
60         (2) As used in this section, the term: 
61         (a) “Applied behavior analysis” means the design, 
62  implementation, and evaluation of environmental modifications, 
63  using behavioral stimuli and consequences, to produce socially 
64  significant improvement in human behavior, including, but not 
65  limited to, the use of direct observation, measurement, and 
66  functional analysis of the relations between environment and 
67  behavior. 
68         (b) “Autism spectrum disorder” means any of the following 
69  disorders as defined in the most recent edition of the 
70  Diagnostic and Statistical Manual of Mental Disorders of the 
71  American Psychiatric Association: 
72         1. Autistic disorder. 
73         2. Asperger’s syndrome. 
74         3. Pervasive developmental disorder not otherwise 
75  specified. 
76         (c) “Developmental disability” means a disorder or syndrome 
77  attributable to cerebral palsy or Down syndrome, which manifests 
78  before the age of 18 years and constitutes a substantial 
79  handicap that can reasonably be expected to continue 
80  indefinitely. As used in this section: 
81         1. “Cerebral palsy” has the same meaning as in s. 393.063. 
82         2. “Down syndrome” means a disorder caused by the presence 
83  of an extra chromosome 21. 
84         (d) “Direct patient access” means the ability of an insured 
85  to obtain services from an in-network provider without a 
86  referral or other authorization before receiving services. 
87         (e)(c) “Eligible individual” means an individual under 18 
88  years of age or an individual 18 years of age or older who is in 
89  high school and who has been diagnosed as having a developmental 
90  disability at 8 years of age or younger. 
91         (f)(d) “Health insurance plan” means a group health 
92  insurance policy or group health benefit plan offered by an 
93  insurer which includes the state group insurance program 
94  provided under s. 110.123. The term does not include a any 
95  health insurance plan offered in the individual market, a any 
96  health insurance plan that is individually underwritten, or a 
97  any health insurance plan provided to a small employer. 
98         (g)(e) “Insurer” means an insurer providing health 
99  insurance coverage, which is licensed to engage in the business 
100  of insurance in this state and is subject to insurance 
101  regulation. 
102         (3) A health insurance plan issued or renewed on or after 
103  April 1, 2009, shall provide coverage to an eligible individual 
104  for: 
105         (a) Direct patient access to an appropriate specialist, as 
106  defined in s. 381.986, for a minimum of three visits per policy 
107  year for the screening for, evaluation of, or diagnosis of 
108  autism spectrum disorder or other developmental disability. 
109         (b)(a) Well-baby and well-child screening for diagnosing 
110  the presence of autism spectrum disorder. 
111         (c)(b) Treatment of autism spectrum disorder or other 
112  developmental disability through speech therapy, occupational 
113  therapy, physical therapy, and applied behavior analysis. 
114  Applied behavior analysis services shall be provided by an 
115  individual certified pursuant to s. 393.17 or an individual 
116  licensed under chapter 490 or chapter 491. 
117         (4) The coverage required pursuant to subsection (3) is 
118  subject to the following requirements: 
119         (a) Coverage shall be limited to treatment that is 
120  prescribed by the insured’s treating physician in accordance 
121  with a treatment plan. 
122         (b) Coverage for the services described in subsection (3) 
123  shall be limited to $36,000 annually and may not exceed $200,000 
124  in total lifetime benefits. 
125         (c) Coverage may not be denied on the basis that provided 
126  services are habilitative in nature. 
127         (d) Coverage may be subject to other general exclusions and 
128  limitations of the insurer’s policy or plan, including, but not 
129  limited to, coordination of benefits, participating provider 
130  requirements, restrictions on services provided by family or 
131  household members, and utilization review of health care 
132  services, including the review of medical necessity, case 
133  management, and other managed care provisions. 
134         (5) The coverage required pursuant to subsection (3) may 
135  not be subject to dollar limits, deductibles, or coinsurance 
136  provisions that are less favorable to an insured than the dollar 
137  limits, deductibles, or coinsurance provisions that apply to 
138  physical illnesses that are generally covered under the health 
139  insurance plan, except as otherwise provided in subsection (4). 
140         (6) An insurer may not deny or refuse to issue coverage for 
141  medically necessary services, refuse to contract with, or refuse 
142  to renew or reissue or otherwise terminate or restrict coverage 
143  for an individual because the individual is diagnosed as having 
144  a developmental disability. 
145         (7) The treatment plan required pursuant to subsection (4) 
146  shall include all elements necessary for the health insurance 
147  plan to appropriately pay claims. These elements include, but 
148  are not limited to, a diagnosis, the proposed treatment by type, 
149  the frequency and duration of treatment, the anticipated 
150  outcomes stated as goals, the frequency with which the treatment 
151  plan will be updated, and the signature of the treating 
152  physician. 
153         (8) Beginning January 1, 2011, the maximum benefit under 
154  paragraph (4)(b) shall be adjusted annually on January 1 of each 
155  calendar year to reflect any change from the previous year in 
156  the medical component of the then current Consumer Price Index 
157  for all urban consumers, published by the Bureau of Labor 
158  Statistics of the United States Department of Labor. 
159         (9) This section may not be construed as limiting benefits 
160  and coverage otherwise available to an insured under a health 
161  insurance plan. 
162         (10) The Office of Insurance Regulation may not enforce 
163  this section against an insurer that is a signatory no later 
164  than April 1, 2009, to the developmental disabilities compact 
165  established under s. 624.916. The Office of Insurance Regulation 
166  shall enforce this section against an insurer that is a 
167  signatory to the compact established under s. 624.916 if the 
168  insurer has not complied with the terms of the compact for all 
169  health insurance plans by April 1, 2010. 
170         Section 3. Subsections (2) and (3) of section 641.31098, 
171  Florida Statutes, are amended to read: 
172         641.31098 Coverage for individuals with developmental 
173  disabilities.— 
174         (2) As used in this section, the term: 
175         (a) “Applied behavior analysis” means the design, 
176  implementation, and evaluation of environmental modifications, 
177  using behavioral stimuli and consequences, to produce socially 
178  significant improvement in human behavior, including, but not 
179  limited to, the use of direct observation, measurement, and 
180  functional analysis of the relations between environment and 
181  behavior. 
182         (b) “Autism spectrum disorder” means any of the following 
183  disorders as defined in the most recent edition of the 
184  Diagnostic and Statistical Manual of Mental Disorders of the 
185  American Psychiatric Association: 
186         1. Autistic disorder. 
187         2. Asperger’s syndrome. 
188         3. Pervasive developmental disorder not otherwise 
189  specified. 
190         (c) “Developmental disability” means a disorder or syndrome 
191  attributable to cerebral palsy or Down syndrome, which manifests 
192  before the age of 18 years and constitutes a substantial 
193  handicap that can reasonably be expected to continue 
194  indefinitely. As used in this section: 
195         1. “Cerebral palsy” has the same meaning as in s. 393.063. 
196         2. “Down syndrome” means a disorder caused by the presence 
197  of an extra chromosome 21. 
198         (d) “Direct patient access” means the ability of an insured 
199  to obtain services from an in-network provider without a 
200  referral or other authorization before receiving services. 
201         (e)(c) “Eligible individual” means an individual under 18 
202  years of age or an individual 18 years of age or older who is in 
203  high school and who has been diagnosed as having a developmental 
204  disability at 8 years of age or younger. 
205         (f)(d) “Health maintenance contract” means a group health 
206  maintenance contract offered by a health maintenance 
207  organization. The This term does not include a health 
208  maintenance contract offered in the individual market, a health 
209  maintenance contract that is individually underwritten, or a 
210  health maintenance contract provided to a small employer. 
211         (3) A health maintenance contract issued or renewed on or 
212  after April 1, 2009, shall provide coverage to an eligible 
213  individual for: 
214         (a) Direct patient access to an appropriate specialist, as 
215  defined in s. 381.986, for a minimum of three visits per policy 
216  year for the screening for, evaluation of, or diagnosis of 
217  autism spectrum disorder or other developmental disability. 
218         (b)(a) Well-baby and well-child screening for diagnosing 
219  the presence of autism spectrum disorder. 
220         (c)(b) Treatment of autism spectrum disorder or other 
221  developmental disability through speech therapy, occupational 
222  therapy, physical therapy, and applied behavior analysis 
223  services. Applied behavior analysis services shall be provided 
224  by an individual certified pursuant to s. 393.17 or an 
225  individual licensed under chapter 490 or chapter 491. 
226         Section 4. This act shall take effect July 1, 2010.