Bill Text: IA SSB1050 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder.
Spectrum: Committee Bill
Status: (Introduced) 2023-02-13 - Subcommittee Meeting: 02/14/2023 1:00PM Room 217 Conference Room. [SSB1050 Detail]
Download: Iowa-2023-SSB1050-Introduced.html
Senate
Study
Bill
1050
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
COMMERCE
BILL
BY
CHAIRPERSON
BROWN)
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
covered
individuals
1
for
the
treatment
of
autism
spectrum
disorder.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
1597XC
(5)
90
ko/rn
S.F.
_____
Section
1.
Section
514C.22,
subsection
3,
paragraph
g,
Code
1
2023,
is
amended
to
read
as
follows:
2
g.
Autistic
disorders
Autism
spectrum
disorder,
as
that
term
3
is
defined
in
section
514C.28,
subsection
2
.
4
Sec.
2.
Section
514C.22,
subsection
4,
Code
2023,
is
amended
5
to
read
as
follows:
6
4.
The
commissioner,
by
rule,
shall
define
the
biologically
7
based
mental
illnesses
identified
in
subsection
3
,
paragraphs
8
“a”
through
“f”
.
Definitions
established
by
the
commissioner
9
shall
be
consistent
with
definitions
provided
in
the
most
10
recent
edition
of
the
American
psychiatric
association’s
11
diagnostic
and
statistical
manual
of
mental
disorders,
as
such
12
definitions
may
be
amended
from
time
to
time.
The
commissioner
13
may
adopt
the
definitions
provided
in
such
manual
by
reference.
14
Sec.
3.
Section
514C.22,
subsection
7,
Code
2023,
is
amended
15
by
adding
the
following
new
paragraph:
16
NEW
PARAGRAPH
.
c.
Notwithstanding
paragraphs
“a”
and
“b”
,
17
a
group
policy,
contract,
or
plan
covered
under
this
section
18
shall
not
impose
an
aggregate
annual
or
lifetime
limit
on
19
biologically
based
mental
illness
coverage
benefits
for
autism
20
spectrum
disorder.
21
Sec.
4.
Section
514C.22,
subsection
8,
unnumbered
paragraph
22
1,
Code
2023,
is
amended
to
read
as
follows:
23
A
group
policy,
contract,
or
plan
covered
under
this
24
section
shall
at
a
minimum
allow
for
thirty
inpatient
days
25
and
fifty-two
outpatient
visits
annually
,
and
shall
not
26
limit
the
number
of
outpatient
visits
a
covered
individual
27
may
have
with
a
practitioner
for
applied
behavior
analysis
28
under
section
514C.31,
or
with
an
autism
service
provider
for
29
treatment
of
autism
spectrum
disorder
under
section
514C.28
.
30
The
policy,
contract,
or
plan
may
also
include
deductibles,
31
coinsurance,
or
copayments,
provided
the
amounts
and
extent
32
of
such
deductibles,
coinsurance,
or
copayments
applicable
to
33
other
health,
medical,
or
surgical
services
coverage
under
the
34
policy,
contract,
or
plan
are
the
same.
It
is
not
a
violation
35
-1-
LSB
1597XC
(5)
90
ko/rn
1/
5
S.F.
_____
of
this
section
if
the
policy,
contract,
or
plan
excludes
1
entirely
from
coverage
benefits
for
the
cost
of
providing
the
2
following:
3
Sec.
5.
Section
514C.22,
subsection
9,
Code
2023,
is
amended
4
to
read
as
follows:
5
9.
This
section
applies
to
third-party
payment
provider
6
policies
or
contracts
and
to
plans
established
pursuant
7
to
chapter
509A
that
are
delivered,
issued
for
delivery,
8
continued,
or
renewed
in
this
state
on
or
after
January
1,
2006
9
2024
.
10
Sec.
6.
Section
514C.28,
subsections
1,
3,
5,
and
13,
Code
11
2023,
are
amended
to
read
as
follows:
12
1.
Notwithstanding
the
uniformity
of
treatment
requirements
13
of
section
514C.6
,
a
group
plan
established
pursuant
to
chapter
14
509A
for
employees
of
the
state
providing
for
third-party
15
payment
or
prepayment
of
health,
medical,
and
surgical
coverage
16
benefits
shall
provide
coverage
benefits
to
covered
individuals
17
under
twenty-one
years
of
age
for
the
diagnostic
assessment
18
of
autism
spectrum
disorder
and
for
the
treatment
of
autism
19
spectrum
disorder.
20
3.
Coverage
is
required
pursuant
to
this
section
in
a
21
maximum
benefit
amount
of
not
more
than
thirty-six
thousand
22
dollars
per
year
but
shall
not
be
subject
to
any
limits
on
23
the
number
of
visits
to
a
covered
individual
may
have
with
24
an
autism
service
provider
for
treatment
of
autism
spectrum
25
disorder.
The
commissioner
shall,
on
or
before
April
1
of
26
each
calendar
year,
publish
an
adjustment
to
the
maximum
27
benefit
required
equal
to
the
percentage
change
in
the
United
28
States
department
of
labor
consumer
price
index
for
all
urban
29
consumers
in
the
preceding
year,
and
the
published
adjusted
30
maximum
benefit
shall
be
applicable
to
group
policies,
31
contracts,
or
plans
subject
to
this
section
that
are
issued
32
or
renewed
on
or
after
January
1
of
the
following
calendar
33
year.
Payments
made
under
a
group
plan
subject
to
this
section
34
on
behalf
of
a
covered
individual
for
treatment
of
a
health
35
-2-
LSB
1597XC
(5)
90
ko/rn
2/
5
S.F.
_____
condition
unrelated
to
or
distinguishable
from
the
individual’s
1
autism
spectrum
disorder
shall
not
be
applied
toward
any
2
maximum
benefit
established
under
this
subsection
.
3
5.
Coverage
required
by
this
section
shall
be
provided
4
in
coordination
with
coverage
required
for
the
treatment
of
5
autistic
disorders
autism
spectrum
disorder
pursuant
to
section
6
514C.22
.
7
13.
This
section
applies
to
plans
established
pursuant
to
8
chapter
509A
for
employees
of
the
state
that
are
delivered,
9
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
10
after
January
1,
2011
2024
.
11
Sec.
7.
Section
514C.31,
subsection
1,
unnumbered
paragraph
12
1,
Code
2023,
is
amended
to
read
as
follows:
13
Notwithstanding
the
uniformity
of
treatment
requirements
of
14
section
514C.6
,
a
group
policy,
contract,
or
plan
providing
15
for
third-party
payment
or
prepayment
of
health,
medical,
and
16
surgical
coverage
benefits
shall
provide
coverage
benefits
for
17
applied
behavior
analysis
provided
by
a
practitioner
to
covered
18
individuals
under
nineteen
years
of
age
for
the
treatment
of
19
autism
spectrum
disorder
pursuant
to
a
treatment
plan
if
the
20
policy,
contract,
or
plan
is
either
of
the
following:
21
Sec.
8.
Section
514C.31,
subsection
3,
Code
2023,
is
amended
22
by
striking
the
subsection.
23
Sec.
9.
Section
514C.31,
subsections
4,
5,
and
10,
Code
24
2023,
are
amended
to
read
as
follows:
25
4.
Coverage
required
pursuant
to
this
section
may
be
26
subject
to
dollar
limits,
deductibles,
copayments,
or
27
coinsurance
provisions
that
apply
to
other
medical
and
surgical
28
services
under
the
policy,
contract,
or
plan
,
subject
to
the
29
requirements
of
subsection
3
.
30
5.
Coverage
required
pursuant
to
this
section
may
be
31
subject
to
care
management
provisions
of
the
applicable
32
policy,
contract,
or
plan,
including
prior
authorization
,
and
33
prior
approval
,
and
limits
on
the
number
of
visits
a
covered
34
individual
may
make
for
applied
behavior
analysis
.
35
-3-
LSB
1597XC
(5)
90
ko/rn
3/
5
S.F.
_____
10.
This
section
applies
to
third-party
provider
payment
1
contracts,
policies,
or
plans
specified
in
subsection
1
,
2
paragraph
“a”
or
to
plans
established
pursuant
to
chapter
509A
3
for
public
employees
other
than
employees
of
the
state,
that
4
are
delivered,
issued
for
delivery,
continued,
or
renewed
in
5
this
state
on
or
after
January
1,
2018
2024
.
6
EXPLANATION
7
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
8
the
explanation’s
substance
by
the
members
of
the
general
assembly.
9
This
bill
relates
to
insurance
coverage
for
covered
10
individuals
for
the
treatment
of
autism
spectrum
disorder
11
(autism).
12
Under
current
law,
a
group
plan
established
pursuant
to
13
Code
chapter
509A
for
employees
of
the
state
that
provides
14
for
third-party
payment
or
prepayment
of
health,
medical,
and
15
surgical
coverage
benefits
(coverage)
shall
provide
coverage
to
16
covered
individuals
under
21
years
of
age
for
the
diagnostic
17
assessment
and
treatment
of
autism,
and
coverage
is
required
18
in
a
maximum
benefit
amount
of
not
more
than
$36,000
per
year.
19
The
bill
eliminates
the
21-year
maximum
age
limit
and
the
20
maximum
benefit
amount.
21
Under
current
law,
a
group
policy,
contract,
or
plan
22
(policy)
providing
for
third-party
payment
or
prepayment
23
of
health,
medical,
and
surgical
coverage
shall
provide
24
coverage
for
applied
behavior
analysis
(analysis)
provided
25
by
a
practitioner
to
covered
individuals
under
19
years
of
26
age
for
the
treatment
of
autism
pursuant
to
a
treatment
plan
27
if
the
policy
is
either
a
policy
issued
by
a
carrier
to
an
28
employer
who
on
at
least
50
percent
of
the
employer’s
working
29
days
during
the
preceding
calendar
year
employed
more
than
50
30
full-time
equivalent
employees,
or
the
policy
is
established
31
pursuant
to
Code
chapter
509A
for
public
employees
other
than
32
employees
of
the
state.
Under
the
bill,
the
age
restriction
33
is
eliminated.
Current
law
requires
that
the
coverage
for
34
analysis
shall
provide
an
annual
maximum
benefit
of
not
less
35
-4-
LSB
1597XC
(5)
90
ko/rn
4/
5
S.F.
_____
than
$36,000
for
individuals
through
age
six,
$25,000
for
1
individuals
age
seven
through
13,
and
$12,500
for
individuals
2
age
14
through
18.
The
bill
eliminates
the
maximum
benefit
3
amounts
and
the
age
categories.
4
The
bill
makes
conforming
changes
to
Code
section
514C.22.
5
The
bill
applies
to
third-party
payment
providers
enumerated
6
in
the
bill.
The
types
of
specialized
health-related
insurance
7
which
are
not
subject
to
the
bill
are
specified
in
the
bill.
8
The
bill
applies
to
plans
delivered,
issued
for
delivery,
9
continued,
or
renewed
in
this
state
on
or
after
January
1,
10
2024.
11
-5-
LSB
1597XC
(5)
90
ko/rn
5/
5
