Bill Text: FL S0100 | 2011 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Autism
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [S0100 Detail]
Download: Florida-2011-S0100-Introduced.html
Bill Title: Autism
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [S0100 Detail]
Download: Florida-2011-S0100-Introduced.html
Florida Senate - 2011 SB 100 By Senator Ring 32-00093A-11 2011100__ 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 term 8 “direct patient access”; requiring that certain 9 insurers and health maintenance organizations provide 10 direct patient access to an appropriate specialist for 11 screening for or evaluation or diagnosis of autism 12 spectrum disorder; requiring certain insurance 13 policies and health maintenance organization contracts 14 to provide a minimum number of visits per year for 15 screening for or evaluation or diagnosis of autism 16 spectrum disorder; providing an effective date. 17 18 Be It Enacted by the Legislature of the State of Florida: 19 20 Section 1. Section 381.986, Florida Statutes, is created to 21 read: 22 381.986 Screening for autism spectrum disorder.— 23 (1) If the parent or legal guardian of a minor believes 24 that the minor exhibits symptoms of autism spectrum disorder, 25 the parent or legal guardian may report his or her observation 26 to a physician licensed in this state. The physician shall 27 perform screening in accordance with American Academy of 28 Pediatrics’ guidelines. If the physician determines that 29 referral to a specialist is medically necessary, the physician 30 shall refer the minor to an appropriate specialist to determine 31 whether the minor meets diagnostic criteria for autism spectrum 32 disorder. If the physician determines that referral to a 33 specialist is not medically necessary, the physician shall 34 inform the parent or legal guardian of the option for the parent 35 or guardian to refer the child to the Early Steps Program or 36 other specialist in autism. This section does not apply to a 37 physician providing care under s. 395.1041. 38 (2) As used in this section, the term “appropriate 39 specialist” means a qualified professional licensed in this 40 state who is experienced in the evaluation of autism spectrum 41 disorder and has training in validated diagnostic tools. The 42 term includes, but is not limited to: 43 (a) A psychologist; 44 (b) A psychiatrist; 45 (c) A neurologist; 46 (d) A developmental or behavioral pediatrician; or 47 (e) A professional whose licensure is deemed appropriate by 48 the Children’s Medical Services Early Steps Program within the 49 Department of Health. 50 Section 2. Section 627.6686, Florida Statutes, is amended 51 to read: 52 627.6686 Coverage for individuals with autism spectrum 53 disorder required; exception.— 54 (1) This section and s. 641.31098 may be cited as the 55 “Steven A. Geller Autism Coverage Act.” 56 (2) As used in this section, the term: 57 (a) “Applied behavior analysis” means the design, 58 implementation, and evaluation of environmental modifications, 59 using behavioral stimuli and consequences, to produce socially 60 significant improvement in human behavior, including, but not 61 limited to, the use of direct observation, measurement, and 62 functional analysis of the relations between environment and 63 behavior. 64 (b) “Autism spectrum disorder” means any of the following 65 disorders as defined in the most recent edition of the 66 Diagnostic and Statistical Manual of Mental Disorders of the 67 American Psychiatric Association: 68 1. Autistic disorder. 69 2. Asperger’s syndrome. 70 3. Pervasive developmental disorder not otherwise 71 specified. 72 (c) “Direct patient access” means the ability of an insured 73 to obtain services from an in-network provider without a 74 referral or other authorization before receiving services. 75 (d)(c)“Eligible individual” means an individual under 18 76 years of age or an individual 18 years of age or older who is in 77 high school and who has been diagnosed as having a developmental 78 disability at 8 years of age or younger. 79 (e)(d)“Health insurance plan” means a group health 80 insurance policy or group health benefit plan offered by an 81 insurer which includes the state group insurance program 82 provided under s. 110.123. The term does not include aany83 health insurance plan offered in the individual market, aany84 health insurance plan that is individually underwritten, or a 85anyhealth insurance plan provided to a small employer. 86 (f)(e)“Insurer” means an insurer providing health 87 insurance coverage, which is licensed to engage in the business 88 of insurance in this state and is subject to insurance 89 regulation. 90 (3) A health insurance plan issued or renewed on or after 91 April 1, 2009, shall provide coverage to an eligible individual 92 for: 93 (a) Direct patient access to an appropriate specialist, as 94 defined in s. 381.986, for a minimum of three visits per policy 95 year for screening for or evaluation or diagnosis of autism 96 spectrum disorder. 97 (b)(a)Well-baby and well-child screening for diagnosing 98 the presence of autism spectrum disorder. 99 (c)(b)Treatment of autism spectrum disorder through speech 100 therapy, occupational therapy, physical therapy, and applied 101 behavior analysis. Applied behavior analysis services shall be 102 provided by an individual certified pursuant to s. 393.17 or an 103 individual licensed under chapter 490 or chapter 491. 104 (4) The coverage required pursuant to subsection (3) is 105 subject to the following requirements: 106 (a) Coverage shall be limited to treatment that is 107 prescribed by the insured’s treating physician in accordance 108 with a treatment plan. 109 (b) Coverage for the services described in subsection (3) 110 shall be limited to $36,000 annually and may not exceed $200,000 111 in total lifetime benefits. 112 (c) Coverage may not be denied on the basis that provided 113 services are habilitative in nature. 114 (d) Coverage may be subject to other general exclusions and 115 limitations of the insurer’s policy or plan, including, but not 116 limited to, coordination of benefits, participating provider 117 requirements, restrictions on services provided by family or 118 household members, and utilization review of health care 119 services, including the review of medical necessity, case 120 management, and other managed care provisions. 121 (5) The coverage required pursuant to subsection (3) may 122 not be subject to dollar limits, deductibles, or coinsurance 123 provisions that are less favorable to an insured than the dollar 124 limits, deductibles, or coinsurance provisions that apply to 125 physical illnesses that are generally covered under the health 126 insurance plan, except as otherwise provided in subsection (4). 127 (6) An insurer may not deny or refuse to issue coverage for 128 medically necessary services, refuse to contract with, or refuse 129 to renew or reissue or otherwise terminate or restrict coverage 130 for an individual because the individual is diagnosed as having 131 a developmental disability. 132 (7) The treatment plan required pursuant to subsection (4) 133 shall include all elements necessary for the health insurance 134 plan to appropriately pay claims. These elements include, but 135 are not limited to, a diagnosis, the proposed treatment by type, 136 the frequency and duration of treatment, the anticipated 137 outcomes stated as goals, the frequency with which the treatment 138 plan will be updated, and the signature of the treating 139 physician. 140 (8) Beginning January 1, 2011, the maximum benefit under 141 paragraph (4)(b) shall be adjusted annually on January 1 of each 142 calendar year to reflect any change from the previous year in 143 the medical component of the then current Consumer Price Index 144 for all urban consumers, published by the Bureau of Labor 145 Statistics of the United States Department of Labor. 146 (9) This section may not be construed as limiting benefits 147 and coverage otherwise available to an insured under a health 148 insurance plan. 149 (10) The Office of Insurance Regulation may not enforce 150 this section against an insurer that is a signatory no later 151 than April 1, 2009, to the developmental disabilities compact 152 established under s. 624.916. The Office of Insurance Regulation 153 shall enforce this section against an insurer that is a 154 signatory to the compact established under s. 624.916 if the 155 insurer has not complied with the terms of the compact for all 156 health insurance plans by April 1, 2010. 157 Section 3. Section 641.31098, Florida Statutes, is amended 158 to read: 159 641.31098 Coverage for individuals with developmental 160 disabilities.— 161 (1) This section and s. 627.6686 may be cited as the 162 “Steven A. Geller Autism Coverage Act.” 163 (2) As used in this section, the term: 164 (a) “Applied behavior analysis” means the design, 165 implementation, and evaluation of environmental modifications, 166 using behavioral stimuli and consequences, to produce socially 167 significant improvement in human behavior, including, but not 168 limited to, the use of direct observation, measurement, and 169 functional analysis of the relations between environment and 170 behavior. 171 (b) “Autism spectrum disorder” means any of the following 172 disorders as defined in the most recent edition of the 173 Diagnostic and Statistical Manual of Mental Disorders of the 174 American Psychiatric Association: 175 1. Autistic disorder. 176 2. Asperger’s syndrome. 177 3. Pervasive developmental disorder not otherwise 178 specified. 179 (c) “Direct patient access” means the ability of an insured 180 to obtain services from an in-network provider without a 181 referral or other authorization before receiving services. 182 (d)(c)“Eligible individual” means an individual under 18 183 years of age or an individual 18 years of age or older who is in 184 high school and who has been diagnosed as having a developmental 185 disability at 8 years of age or younger. 186 (e)(d)“Health maintenance contract” means a group health 187 maintenance contract offered by a health maintenance 188 organization. TheThisterm does not include a health 189 maintenance contract offered in the individual market, a health 190 maintenance contract that is individually underwritten, or a 191 health maintenance contract provided to a small employer. 192 (3) A health maintenance contract issued or renewed on or 193 after April 1, 2009, shall provide coverage to an eligible 194 individual for: 195 (a) Direct patient access to an appropriate specialist, as 196 defined in s. 381.986, for a minimum of three visits per policy 197 year for screening for or evaluation or diagnosis of autism 198 spectrum disorder. 199 (b)(a)Well-baby and well-child screening for diagnosing 200 the presence of autism spectrum disorder. 201 (c)(b)Treatment of autism spectrum disorder through speech 202 therapy, occupational therapy, physical therapy, and applied 203 behavior analysis services. Applied behavior analysis services 204 shall be provided by an individual certified pursuant to s. 205 393.17 or an individual licensed under chapter 490 or chapter 206 491. 207 (4) The coverage required pursuant to subsection (3) is 208 subject to the following requirements: 209 (a) Coverage shall be limited to treatment that is 210 prescribed by the subscriber’s treating physician in accordance 211 with a treatment plan. 212 (b) Coverage for the services described in subsection (3) 213 shall be limited to $36,000 annually and may not exceed $200,000 214 in total benefits. 215 (c) Coverage may not be denied on the basis that provided 216 services are habilitative in nature. 217 (d) Coverage may be subject to general exclusions and 218 limitations of the subscriber’s contract, including, but not 219 limited to, coordination of benefits, participating provider 220 requirements, and utilization review of health care services, 221 including the review of medical necessity, case management, and 222 other managed care provisions. 223 (5) The coverage required pursuant to subsection (3) may 224 not be subject to dollar limits, deductibles, or coinsurance 225 provisions that are less favorable to a subscriber than the 226 dollar limits, deductibles, or coinsurance provisions that apply 227 to physical illnesses that are generally covered under the 228 subscriber’s contract, except as otherwise provided in 229 subsection (3). 230 (6) A health maintenance organization may not deny or 231 refuse to issue coverage for medically necessary services, 232 refuse to contract with, or refuse to renew or reissue or 233 otherwise terminate or restrict coverage for an individual 234 solely because the individual is diagnosed as having a 235 developmental disability. 236 (7) The treatment plan required pursuant to subsection (4) 237 shall include, but is not limited to, a diagnosis, the proposed 238 treatment by type, the frequency and duration of treatment, the 239 anticipated outcomes stated as goals, the frequency with which 240 the treatment plan will be updated, and the signature of the 241 treating physician. 242 (8) Beginning January 1, 2011, the maximum benefit under 243 paragraph (4)(b) shall be adjusted annually on January 1 of each 244 calendar year to reflect any change from the previous year in 245 the medical component of the then current Consumer Price Index 246 for all urban consumers, published by the Bureau of Labor 247 Statistics of the United States Department of Labor. 248 (9) The Office of Insurance Regulation may not enforce this 249 section against a health maintenance organization that is a 250 signatory no later than April 1, 2009, to the developmental 251 disabilities compact established under s. 624.916. The Office of 252 Insurance Regulation shall enforce this section against a health 253 maintenance organization that is a signatory to the compact 254 established under s. 624.916 if the health maintenance 255 organization has not complied with the terms of the compact for 256 all health maintenance contracts by April 1, 2010. 257 Section 4. This act shall take effect July 1, 2011.