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Requires all health benefit plans issued or renewed after July 1, 2010 to provide coverage for the assessment, diagnosis, and treatment of autism spectrum disorders for a child. Treatments include: evaluation and assessment services; Behavior training and behavior management and applied behavior analysis; habilitative or rehabilitative care, including, but not limited to, occupational therapy, physical therapy, or speech therapy, or any combination of those therapies; pharmacy care and medication; psychiatric care; psychological care; and therapeutic care, including, but is not limited to, speech, occupational, and applied behavior analytic and physical therapies.
Requires certain health insurers to provide individuals under 21 years of age coverage for the diagnosis of autism spectrum disorders and for the treatment of autism spectrum disorders. Treatment includes the following care prescribed, provided, or ordered for an individual diagnosed with an autism spectrum disorder by (A) a physician licensed to practice medicine in all its branches, or (B) a certified, registered, or licensed health care professional with expertise in treating effects of autism spectrum disorders when the care is determined to be medically necessary and ordered by a physician licensed to practice medicine in all its branches; psychiatric care, meaning direct, consultative, or diagnostic services provided by a licensed psychiatrist; psychological care, meaning direct or consultative services provided by a licensed psychologist; habilitative or rehabilitative care, meaning professional, counseling, and guidance services and treatment programs, including applied behavior analysis, that are intended to develop, maintain, and restore the functioning of an individual; therapeutic care, including behavioral, speech, occupational, and physical therapies. Coverage provided shall be subject to a maximum benefit of $36,000 per year, but shall not be subject to any limits on the number of visits to a service provider.
Requires insurers and nonprofit health service plans and health maintenance organizations to provide coverage for habilitative services to children under the age of 19 years coverage who have a congenital or genetic birth defect (including autism). Habilitative services include speech therapy.
Requires specified health insurance policies and health benefit plans to provide benefits for treatment of autism or other developmental disability. Coverage shall include: medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan. The maximum benefit amount for a covered person in any calendar year through 2012 shall be $37,080.
Requires a health insurance policy or government program to provide coverage for individuals less than 21 years of age for the diagnostic assessment and treatment of autism spectrum disorder. Treatment includes: pharmacy care, psychiatric care, psychological care, rehabilitative care and therapeutic care (includes services provided by speech language pathologists, occupational therapists or physical therapists) that is medically necessary and prescribed, ordered or provided by a licensed physician, licensed physician assistant, licensed psychologist, licensed clinical social worker or certified registered nurse practitioner. Coverage provided under this section by an insurer shall be subject to a maximum benefit of $37,080 per year and is not subject to any limits on the number of visits to an autism service provider for treatment of autism spectrum disorders.
Requires health insurance plans issued or renewed after January 1, 2012, to provide coverage for the diagnosis and the treatment of autism spectrum disorder in individuals from age two through age six. An individual who is being treated and continues to need treatment for autism spectrum disorder and becomes seven years of age or older is not precluded from coverage of treatment and services. Treatment shall be determined by a licensed physician or a licensed psychologist to be medically necessary, and includes: (i) behavioral health treatment, (ii) pharmacy care, (iii) psychiatric care, (iv) psychological care, (v) therapeutic care (which includes services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers), and (vi) applied behavior analysis when provided or supervised by a board certified behavior analyst who shall be licensed by the Board of Medicine. Certain insurers may be exempt from requirements for 1 year and may reapply for the exemption yearly.
Requires the essential health benefits benchmark plan to include habilitative services, including applied behavioral analysis for the treatment of autism spectrum disorder.