Bill Text: MI SB0359 | 2009-2010 | 95th Legislature | Introduced
Bill Title: Insurance; health; coverage for certain treatments related to autism; provide for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406s.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced - Dead) 2009-03-11 - Referred To Committee On Economic Development And Regulatory Reform [SB0359 Detail]
Download: Michigan-2009-SB0359-Introduced.html
SENATE BILL No. 359
March 11, 2009, Introduced by Senators HUNTER, BARCIA, WHITMER, THOMAS, GLEASON, SCOTT, BRATER and CLARKE and referred to the Committee on Economic Development and Regulatory Reform.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406s.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406s. (1) An expense-incurred hospital, medical, or
surgical policy or certificate delivered, issued for delivery, or
renewed in this state and a health maintenance organization
contract shall provide coverage for the screening, diagnosis, and
treatment of autism spectrum disorder, including, but not limited
to, coverage for speech therapy, occupational therapy, physical
therapy, psychological services, psychiatric services, and applied
behavioral analysis, as prescribed or ordered by the insured's or
enrollee's treating physician or psychologist.
(2) Coverage for autism spectrum disorder under this section
is subject to the same terms and conditions that the insurer or
health maintenance organization applies to the treatment of other
disorders, except as follows:
(a) Treatment shall not be limited or denied on the basis that
it is habilitative in nature.
(b) Treatment shall not be subject to visit limits.
(3) If an insured or enrollee is receiving treatment for
autism spectrum disorder, an insurer or health maintenance
organization may request a review of that treatment not more than
once every 6 months unless the insurer or health maintenance
organization and the insured's or enrollee's treating physician or
psychologist agree that a more frequent review is necessary. The
cost of obtaining this review shall be borne by the insurer or
health maintenance organization.
(4) This section shall not be construed as limiting benefits
that are otherwise available to an insured or enrollee with autism
spectrum disorder.
(5) As used in this section:
(a) "Applied behavior analysis" means the 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.
(b) "Autism spectrum disorder" means any of the pervasive
developmental disorders as defined by the most recent edition of
the diagnostic and statistical manual of mental disorders (DSM),
including autistic disorder, Asperger's disorder, and pervasive
developmental disorder not otherwise specified.
