Bill Text: MI SB0415 | 2011-2012 | 96th Legislature | Introduced
Bill Title: Insurance; health; coverage for certain treatment related to autism; provide for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406s. TIE BAR WITH: SB 0414'11, SB 0981'12
Spectrum: Bipartisan Bill
Status: (Passed) 2012-04-19 - Assigned Pa 0100'12 With Immediate Effect [SB0415 Detail]
Download: Michigan-2011-SB0415-Introduced.html
SENATE BILL No. 415
June 8, 2011, Introduced by Senators HUNTER, CASWELL, RICHARDVILLE, EMMONS, GLEASON, SMITH, WHITMER, BIEDA, YOUNG, HOOD, GREGORY, JOHNSON, PAPPAGEORGE, BOOHER and WARREN and referred to the Committee on Health Policy.
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 group or individual policy or certificate delivered,
issued for delivery, or renewed in this state and a health
maintenance organization group or individual contract shall provide
coverage for the diagnosis and treatment of autism spectrum
disorders. An insurer and a health maintenance organization shall
not terminate coverage or refuse to deliver, execute, issue, amend,
adjust, or renew coverage solely because an individual is diagnosed
with, or has received treatment for, an autism spectrum disorder.
(2) Coverage under this section is not subject to limits on
the number of visits an insured or enrollee may use for treatment
of autism spectrum disorders.
(3) Coverage under this section shall not be denied or limited
on the basis that it is educational or habilitative in nature.
(4) Except as provided in subsection (5), coverage under this
section shall not be subject to dollar limits, copays, deductibles,
or coinsurance provisions that do not apply to physical illness
generally.
(5) Coverage under this section for applied behavior analysis
may be subject to a maximum annual benefit of $50,000.00 and may be
limited to an insured or enrollee up to age 18.
(6) This section shall not be construed as limiting benefits
that are otherwise available to an insured or enrollee under a
policy or certificate.
(7) 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 consistent with
current protocols and may require a treatment plan. The cost of
obtaining a treatment review shall be borne by the insurer or
health maintenance organization. An insurer or health maintenance
organization shall utilize evidence-based care and managed care
cost-containment practices in accordance with the insurer's or
health maintenance organization's procedures so long as that care
and those practices are consistent with this section.
(8) This section does not apply to a short-term or 1-time
limited duration policy or certificate of no longer than 6 months
as defined in section 2213b.
(9) 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 significant
improvement in human behavior, including the use of direct
observation, measurement, and functional analysis of the
relationship between environment and behavior.
(b) "Autism spectrum disorders" means any of the following
pervasive developmental disorders as defined by the "Diagnostic and
Statistical Manual of Mental Disorders" of the American psychiatric
association:
(i) Autistic disorder.
(ii) Asperger's disorder.
(iii) Pervasive developmental disorder not otherwise specified.
(c) "Behavioral health treatment" means professional,
counseling, and guidance services and treatment programs, including
applied behavior analysis if provided or supervised by a certified
behavior analyst, that are necessary to develop, maintain, and
restore, to the maximum extent practicable, the functioning of an
individual.
(d) "Diagnosis of autism spectrum disorders" means
assessments, evaluations, or tests performed by a licensed
physician or a licensed psychologist to diagnose whether an
individual has 1 of the autism spectrum disorders.
(e) "Pharmacy care" means medications prescribed by a licensed
physician and related services performed by a licensed pharmacist
and any health-related services considered medically necessary to
determine the need or effectiveness of the medications.
(f) "Psychiatric care" means direct or consultative services
provided by a psychiatrist licensed in the state in which the
psychiatrist practices.
(g) "Psychological care" means direct or consultative services
provided by a psychologist licensed in the state in which the
psychologist practices.
(h) "Therapeutic care" means services provided by a licensed
or certified speech therapist, occupational therapist, physical
therapist, or social worker.
(i) "Treatment of autism spectrum disorders" means evidence-
based treatment that includes the following care prescribed or
ordered for an individual diagnosed with 1 of the autism spectrum
disorders by a licensed physician or a licensed psychologist who
determines the care to be medically necessary:
(i) Behavioral health treatment.
(ii) Pharmacy care.
(iii) Psychiatric care.
(iv) Psychological care.
(v) Therapeutic care.
(j) "Treatment plan" means a written comprehensive evaluation
by a multidisciplinary team, individualized for each patient and
developed by a licensed physician or licensed psychologist.
Enacting section 1. This amendatory act applies to policies,
certificates, and contracts delivered, executed, issued, amended,
adjusted, or renewed in this state, or outside this state if
covering residents of this state, beginning 180 days after the date
this amendatory act is enacted into law.
