Bill Text: IA HF243 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder.(Formerly HSB 74.)

Spectrum: Committee Bill

Status: (Engrossed - Dead) 2023-02-21 - Subcommittee: Westrich, Petersen, and Schultz. S.J. 372. [HF243 Detail]

Download: Iowa-2023-HF243-Introduced.html

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House File 243 - Introduced
HOUSE FILE 243
BY COMMITTEE ON COMMERCE
(SUCCESSOR TO HSB 74)
A BILL FOR
An Act relating to insurance coverage for covered individuals
for the treatment of autism spectrum disorder.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. Section 514C.22, subsection 3, paragraph g, Code
2023, is amended to read as follows:
g. Autistic disorders Autism spectrum disorder, as that term
is defined in section 514C.28, subsection 2 .
Sec. 2. Section 514C.22, subsection 4, Code 2023, is amended
to read as follows:
4. The commissioner, by rule, shall define the biologically
based mental illnesses identified in subsection 3 , paragraphs
“a” through “f” . Definitions established by the commissioner
shall be consistent with definitions provided in the most
recent edition of the American psychiatric association’s
diagnostic and statistical manual of mental disorders, as such
definitions may be amended from time to time. The commissioner
may adopt the definitions provided in such manual by reference.
Sec. 3. Section 514C.22, subsection 7, Code 2023, is amended
by adding the following new paragraph:
NEW PARAGRAPH . c. Notwithstanding paragraphs “a” and “b” ,
a group policy, contract, or plan covered under this section
shall not impose an aggregate annual or lifetime limit on
biologically based mental illness coverage benefits for autism
spectrum disorder.
Sec. 4. Section 514C.22, subsection 8, unnumbered paragraph
1, Code 2023, is amended to read as follows:
A group policy, contract, or plan covered under this
section shall at a minimum allow for thirty inpatient days
and fifty-two outpatient visits annually , and shall not
limit the number of outpatient visits a covered individual
may have with a practitioner for applied behavior analysis
under section 514C.31, or with an autism service provider for
treatment of autism spectrum disorder under section 514C.28 .
The policy, contract, or plan may also include deductibles,
coinsurance, or copayments, provided the amounts and extent
of such deductibles, coinsurance, or copayments applicable to
other health, medical, or surgical services coverage under the
policy, contract, or plan are the same. It is not a violation
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H.F. 243
of this section if the policy, contract, or plan excludes
entirely from coverage benefits for the cost of providing the
following:
Sec. 5. Section 514C.22, subsection 9, Code 2023, is amended
to read as follows:
9. This section applies to third-party payment provider
policies or contracts and to plans established pursuant
to chapter 509A that are delivered, issued for delivery,
continued, or renewed in this state on or after January 1, 2006
2024 .
Sec. 6. Section 514C.28, subsections 1, 3, 5, and 13, Code
2023, are amended to read as follows:
1. Notwithstanding the uniformity of treatment requirements
of section 514C.6 , a group plan established pursuant to chapter
509A for employees of the state providing for third-party
payment or prepayment of health, medical, and surgical coverage
benefits shall provide coverage benefits to covered individuals
under twenty-one years of age for the diagnostic assessment
of autism spectrum disorder and for the treatment of autism
spectrum disorder.
3. Coverage is required pursuant to this section in a
maximum benefit amount of not more than thirty-six thousand
dollars per year but shall not be subject to any limits on
the number of visits to a covered individual may have with
an autism service provider for treatment of autism spectrum
disorder. The commissioner shall, on or before April 1 of
each calendar year, publish an adjustment to the maximum
benefit required equal to the percentage change in the United
States department of labor consumer price index for all urban
consumers in the preceding year, and the published adjusted
maximum benefit shall be applicable to group policies,
contracts, or plans subject to this section that are issued
or renewed on or after January 1 of the following calendar
year. Payments made under a group plan subject to this section
on behalf of a covered individual for treatment of a health
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H.F. 243
condition unrelated to or distinguishable from the individual’s
autism spectrum disorder shall not be applied toward any
maximum benefit established under this subsection .
5. Coverage required by this section shall be provided
in coordination with coverage required for the treatment of
autistic disorders autism spectrum disorder pursuant to section
514C.22 .
13. This section applies to plans established pursuant to
chapter 509A for employees of the state that are delivered,
issued for delivery, continued, or renewed in this state on or
after January 1, 2011 2024 .
Sec. 7. Section 514C.31, subsection 1, unnumbered paragraph
1, Code 2023, is amended to read as follows:
Notwithstanding the uniformity of treatment requirements of
section 514C.6 , a group policy, contract, or plan providing
for third-party payment or prepayment of health, medical, and
surgical coverage benefits shall provide coverage benefits for
applied behavior analysis provided by a practitioner to covered
individuals under nineteen years of age for the treatment of
autism spectrum disorder pursuant to a treatment plan if the
policy, contract, or plan is either of the following:
Sec. 8. Section 514C.31, subsection 3, Code 2023, is amended
by striking the subsection.
Sec. 9. Section 514C.31, subsections 4, 5, and 10, Code
2023, are amended to read as follows:
4. Coverage required pursuant to this section may be
subject to dollar limits, deductibles, copayments, or
coinsurance provisions that apply to other medical and surgical
services under the policy, contract, or plan , subject to the
requirements of subsection 3 .
5. Coverage required pursuant to this section may be
subject to care management provisions of the applicable
policy, contract, or plan, including prior authorization , and
prior approval , and limits on the number of visits a covered
individual may make for applied behavior analysis .
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H.F. 243
10. This section applies to third-party provider payment
contracts, policies, or plans specified in subsection 1 ,
paragraph “a” or to plans established pursuant to chapter 509A
for public employees other than employees of the state, that
are delivered, issued for delivery, continued, or renewed in
this state on or after January 1, 2018 2024 .
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to insurance coverage for covered
individuals for the treatment of autism spectrum disorder
(autism).
Under current law, a group plan established pursuant to
Code chapter 509A for employees of the state that provides
for third-party payment or prepayment of health, medical, and
surgical coverage benefits (coverage) shall provide coverage to
covered individuals under 21 years of age for the diagnostic
assessment and treatment of autism, and coverage is required
in a maximum benefit amount of not more than $36,000 per year.
The bill eliminates the 21-year maximum age limit and the
maximum benefit amount.
Under current law, a group policy, contract, or plan
(policy) providing for third-party payment or prepayment
of health, medical, and surgical coverage shall provide
coverage for applied behavior analysis (analysis) provided
by a practitioner to covered individuals under 19 years of
age for the treatment of autism pursuant to a treatment plan
if the policy is either a policy issued by a carrier to an
employer who on at least 50 percent of the employer’s working
days during the preceding calendar year employed more than 50
full-time equivalent employees, or the policy is established
pursuant to Code chapter 509A for public employees other than
employees of the state. Under the bill, the age restriction
is eliminated. Current law requires that the coverage for
analysis shall provide an annual maximum benefit of not less
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than $36,000 for individuals through age six, $25,000 for
individuals age seven through 13, and $12,500 for individuals
age 14 through 18. The bill eliminates the maximum benefit
amounts and the age categories.
The bill makes conforming changes to Code section 514C.22.
The bill applies to third-party payment providers enumerated
in the bill. The types of specialized health-related insurance
which are not subject to the bill are specified in the bill.
The bill applies to plans delivered, issued for delivery,
continued, or renewed in this state on or after January 1,
2024.
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