Bill H.3809 186th (2009 - 2010)

HOUSE DOCKET, NO. 984        FILED ON: 1/13/2009

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 3809

The Commonwealth of Massachusetts

_______________

PRESENTED BY:

Barbara A. L'Italien

_______________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
              Court assembled:

              The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying bill:

An Act relative to insurance coverage for autism.

_______________

PETITION OF:

 

Name:	District/Address:
Barbara A. L'Italien	18th Essex
Frederick E. Berry
Frank I. Smizik	15th Norfolk
Stephen L. DiNatale	3rd Worcester
Robert L. Rice, Jr.	2nd Worcester
Ellen Story	3rd Hampshire
Brian A. Joyce	Norfolk, Bristol and Plymouth
Tom Sannicandro	7th Middlesex
Matthew C. Patrick	3rd Barnstable
Katherine Clark	32nd Middlesex
James R. Miceli	19th Middlesex
Steven A. Tolman	Second Suffolk and Middlesex
William N. Brownsberger	24th Middlesex
Lori Ehrlich	8th Essex
Scott P. Brown	Norfolk, Bristol and Middlesex
Garrett J. Bradley	3rd Plymouth
Angelo J. Puppolo, Jr.	12th Hampden
Christine E. Canavan	10th Plymouth
David B. Sullivan	6th Bristol
David P. Linsky	5th Middlesex
Stephen R. Canessa	12th Bristol
Michael R. Knapik	Second Hampden and Hampshire
James E. Vallee	10th Norfolk
F. Jay Barrows	1st Bristol
Carlo P. Basile	1st Suffolk
Michael J. Rodrigues	8th Bristol
Rosemary Sandlin	3rd Hampden
Martha M. Walz	8th Suffolk
Joan M. Menard	First Bristol and Plymouth
Thomas M. Stanley	9th Middlesex
John W. Scibak	2nd Hampshire
Patricia D. Jehlen	Second Middlesex
Cheryl A. Coakley-Rivera	10th Hampden
Richard R. Tisei	Middlesex and Essex
Thomas J. Calter	12th Plymouth
Harriette L. Chandler	First Worcester
Antonio F.D. Cabral	13th Bristol
Kay Khan	11th Middlesex
Susan C. Tucker	Second Essex and Middlesex
Carl M. Sciortino, Jr.	34th Middlesex
Donald F. Humason, Jr.	4th Hampden
Jay R. Kaufman	15th Middlesex
Sarah K. Peake	4th Barnstable
Alice K. Wolf	25th Middlesex
Robert S. Hargraves	1st Middlesex
Sean Garballey	23rd Middlesex
Jennifer Benson	37th Middlesex
Anne M. Gobi	5th Worcester
Steven M. Walsh	11th Essex
Marc R. Pacheco	First Plymouth and Bristol
Michael F. Rush	10th Suffolk
Geraldo Alicea	6th Worcester
Thomas P. Conroy	13th Middlesex
John V. Fernandes	10th Worcester
Brian P. Wallace	4th Suffolk
Geraldine Creedon	11th Plymouth
Theodore C. Speliotis	13th Essex
Danielle W. Gregoire	4th Middlesex
James E. Timilty	Bristol and Norfolk
Colleen M. Garry	36th Middlesex
Allen J. McCarthy	7th Plymouth
Cynthia Stone Creem	First Middlesex and Norfolk
Jennifer M. Callahan	18th Worcester
Ruth B. Balser	12th Middlesex
James Dwyer	30th Middlesex
Peter v. Kocot	1st Hampshire
Eugene L. O'Flaherty	2nd Suffolk
Stephen M. Brewer	Worcester, Hampden, Hampshire and Franklin
John P. Fresolo	16th Worcester
Thomas P. Kennedy	Second Plymouth and Bristol
Jennifer L. Flanagan	Worcester and Middlesex
John D. Keenan	7th Essex
James T. Welch	6th Hampden
Kate Hogan	3rd Middlesex
Denise Provost	27th Middlesex
Mary E. Grant	6th Essex
Thomas A. Golden, Jr.	16th Middlesex
Susan C. Fargo	Third Middlesex
Kenneth J. Donnelly	Fourth Middlesex
James B. Eldridge	Middlesex and Worcester
John A. Hart, Jr.	First Suffolk
Steven A. Baddour	First Essex
Anthony W. Petruccelli	First Suffolk and Middlesex
Paul J. Donato	35th Middlesex
Denis E. Guyer	2nd Berkshire
Linda Dean Campbell	15th Essex
Richard J. Ross	9th Norfolk
Michael O. Moore	Second Worcester
Lida E. Harkins	13th Norfolk
James Cantwell	4th Plymouth
A. Stephen Tobin	2nd Norfolk
Marian Walsh	Suffolk and Norfolk
Christopher G. Fallon	33rd Middlesex
Robert F. Fennell	10th Essex
Robert L. Rice, Jr.	2nd Worcester
Joyce A. Spiliotis	12th Essex
Elizabeth A. Malia	11th Suffolk
Jonathan Hecht	29th Middlesex
William Lantigua	16th Essex
Mark V. Falzone	9th Essex
Kathi-Anne Reinstein	16th Suffolk
Anthony D. Galluccio	Middlesex, Suffolk and Essex
Steven J. D'Amico	4th Bristol
Paul McMurtry	11th Norfolk
Kevin G. Honan	17th Suffolk
Louis L. Kafka	8th Norfolk
Bruce E. Tarr	First Essex and Middlesex
Kevin J. Murphy	18th Middlesex
Cleon H. Turner	1st Barnstable
Carolyn Dykema	8th Middlesex
Joseph R. Driscoll, Jr.	5th Norfolk

The Commonwealth of Massachusetts
 

_______________

In the Year Two Thousand and Nine

_______________

 

An Act relative to insurance coverage for autism.


 

              Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1.  Chapter 32A of the General Laws is hereby amended by adding the following section:-

Section 24. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission benefits on a nondiscriminatory basis to residents of the commonwealth and to all policyholders having a principal place of employment in the commonwealth for the diagnosis and treatment of Autism Spectrum Disorder in individuals.

(b) Any such policy shall be deemed to be providing such benefits on a nondiscriminatory basis if the policy does not contain any annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of said Autism Spectrum Disorders which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions. (c) This section will not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(d) Coverage under this section will not be subject to any limits on the number of visits an individual may make to an autism services provider. (e) This section will not be construed   as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan. (f)   Definitions - As used in this section:

1. “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 relationship between environment and behavior.

2. “Autism services provider” means any person, entity, or group that provides treatment of autism spectrum disorders.

3. “Autism spectrum disorders” means any of the Pervasive Developmental Disorders (PDD) as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder, and PDD Not Otherwise Specified.

4. "Board Certified Behavior Analyst" means a behavior analyst credentialed by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst.

5. “Diagnosis of autism spectrum disorders” means medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has one of the autism spectrum disorders.

6. “Habilitative or rehabilitative care” means professional, counseling, and guidance services and treatment programs, including applied behavior analysis supervised by a Board Certified Behavior Analyst, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.

7. “Pharmacy care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the policy for other medical conditions.

8. “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.

9. “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

10. “Therapeutic care” means services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers.

11. “Treatment of Autism Spectrum Disorders” will include the following care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:

a . habilitative or rehabilitative care;

b . pharmacy care;

c . psychiatric care;

d . psychological care; and

e . therapeutic care.

SECTION 2. C hapter 175 of the General Laws is hereby amended by inserting the following new section after section 47T:-

Section 47U

(a) Any individual policy of accident and sickness insurance issued pursuant to section 108, which provides hospital expense and surgical expense insurance, and any group blanket or general policy of accident and sickness insurance issued pursuant to section 110, which provides hospital expense and surgical expense insurance, which is issued or renewed within or without the commonwealth, shall provide benefits on a nondiscriminatory basis to residents of the commonwealth and to all policyholders having a principal place of employment in the commonwealth for the diagnosis and treatment of Autism Spectrum Disorder in individuals.

(b) Any such policy shall be deemed to be providing such benefits on a nondiscriminatory basis if the policy does not contain any annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of said Autism Spectrum Disorders which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.

(c) This section will not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(d) Coverage under this section will not be subject to any limits on the number of visits an individual may make to an autism services provider.

(e) This section will not be construed   as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan.

(f)   Definitions - As used in this section:

1. “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 relationship between environment and behavior.

2. “Autism services provider” means any person, entity, or group that provides treatment of autism spectrum disorders.

3. “Autism spectrum disorders” means any of the Pervasive Developmental Disorders (PDD) as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder, and PDD Not Otherwise Specified.

4. "Board Certified Behavior Analyst" means a behavior analyst credentialed by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst.

5. “Diagnosis of autism spectrum disorders” means medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has one of the autism spectrum disorders.

6. “Habilitative or rehabilitative care” means professional, counseling, and guidance services and treatment programs, including applied behavior analysis supervised by a Board Certified Behavior Analyst, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.

7. “Pharmacy care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the policy for other medical conditions.

8. “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.

9. “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

10. “Therapeutic care” means services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers.

11. “Treatment of Autism Spectrum Disorders” will include the following care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:

a . habilitative or rehabilitative care;

b . pharmacy care;

c . psychiatric care;

d . psychological care; and

e . therapeutic care.

SECTION 3.  Chapter 176A of the General Laws is hereby amended by inserting after section 8AA, the following section:-

Section 8AB. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan which is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis to residents of the commonwealth and to all policyholders having a principal place of employment in the commonwealth for the diagnosis and treatment of Autism Spectrum Disorder in individuals.

(b) Any such policy shall be deemed to be providing such benefits on a nondiscriminatory basis if the policy does not contain any annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of said Autism Spectrum Disorders which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.

(c) This section will not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(d) Coverage under this section will not be subject to any limits on the number of visits an individual may make to an autism services provider.

(e) This section will not be construed   as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan.

(f)   Definitions - As used in this section:

1. “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 relationship between environment and behavior.

2. “Autism services provider” means any person, entity, or group that provides treatment of autism spectrum disorders.

3. “Autism spectrum disorders” means any of the Pervasive Developmental Disorders (PDD) as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder, and PDD Not Otherwise Specified.

4. "Board Certified Behavior Analyst" means a behavior analyst credentialed by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst.

5. “Diagnosis of autism spectrum disorders” means medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has one of the autism spectrum disorders.

6. “Habilitative or rehabilitative care” means professional, counseling, and guidance services and treatment programs, including applied behavior analysis supervised by a Board Certified Behavior Analyst, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.

7. “Pharmacy care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the policy for other medical conditions.

8. “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.

9. “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

10. “Therapeutic care” means services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers.

11. “Treatment of Autism Spectrum Disorders” will include the following care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:

a . habilitative or rehabilitative care;

b . pharmacy care;

c . psychiatric care;

d . psychological care; and

e . therapeutic care.

SECTION 4. Chapter 176B of the General Laws is hereby amended by inserting after section 4R, the following section:-

Section 4S. (a) Any subscription certificate under an individual or group medical service agreement which is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis to residents of the commonwealth and to all policyholders having a principal place of employment in the commonwealth for the diagnosis and treatment of Autism Spectrum Disorder in individuals.

(b) Any such policy shall be deemed to be providing such benefits on a nondiscriminatory basis if the policy does not contain any annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of said Autism Spectrum Disorders which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.

(c) This section will not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(d) Coverage under this section will not be subject to any limits on the number of visits an individual may make to an autism services provider.

(e) This section will not be construed   as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan.

(f)   Definitions - As used in this section:

1. “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 relationship between environment and behavior.

2. “Autism services provider” means any person, entity, or group that provides treatment of autism spectrum disorders.

3. “Autism spectrum disorders” means any of the Pervasive Developmental Disorders (PDD) as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder, and PDD Not Otherwise Specified.

4. "Board Certified Behavior Analyst" means a behavior analyst credentialed by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst.

5. “Diagnosis of autism spectrum disorders” means medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has one of the autism spectrum disorders.

6. “Habilitative or rehabilitative care” means professional, counseling, and guidance services and treatment programs, including applied behavior analysis supervised by a Board Certified Behavior Analyst, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.

7. “Pharmacy care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the policy for other medical conditions.

8. “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.

9. “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

10. “Therapeutic care” means services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers.

11. “Treatment of Autism Spectrum Disorders” will include the following care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:

a . habilitative or rehabilitative care;

b . pharmacy care;

c . psychiatric care;

d . psychological care; and

e . therapeutic care.

SECTION 5. Said chapter 176G is hereby amended by inserting after section 4Q, as so appearing, the following section:-

Section 4R. (a) A health maintenance contract issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis to residents of the commonwealth and to all policyholders having a principal place of employment in the commonwealth for the diagnosis and treatment of Autism Spectrum Disorder in individuals.

(b) Any such policy shall be deemed to be providing such benefits on a nondiscriminatory basis if the policy does not contain any annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of said Autism Spectrum Disorders which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.

(c) This section will not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(d) Coverage under this section will not be subject to any limits on the number of visits an individual may make to an autism services provider.

(e) This section will not be construed   as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan.

(f)   Definitions - As used in this section:

1. “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 relationship between environment and behavior.

2. “Autism services provider” means any person, entity, or group that provides treatment of autism spectrum disorders.

3. “Autism spectrum disorders” means any of the Pervasive Developmental Disorders (PDD) as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder, and PDD Not Otherwise Specified.

4. "Board Certified Behavior Analyst" means a behavior analyst credentialed by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst.

5. “Diagnosis of autism spectrum disorders” means medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has one of the autism spectrum disorders.

6. “Habilitative or rehabilitative care” means professional, counseling, and guidance services and treatment programs, including applied behavior analysis supervised by a Board Certified Behavior Analyst, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.

7. “Pharmacy care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the policy for other medical conditions.

8. “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.

9. “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

10. “Therapeutic care” means services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers.

11. “Treatment of Autism Spectrum Disorders” will include the following care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:

a . habilitative or rehabilitative care;

b . pharmacy care;

c . psychiatric care;

d . psychological care; and

e . therapeutic care.

SECTION 6.   All policies, contracts and certificates of health insurance subject to the provisions of section 24 of chapter 32A, section 47U of chapter 175, section 8AB of chapter 176A, section 4S of chapter 176B, and section 4R of chapter 176G of the General Laws which are delivered, issued, or renewed on or after January 1, 2010 shall conform with the provisions of this act. Form filings implementing this act shall be subject to the approval of the commissioner of insurance.

SECTION 7.  This act shall take effect on January 1, 2010.