Bill Text: MI SB0038 | 2011-2012 | 96th Legislature | Introduced
Bill Title: Insurance; health; coverage for certain treatments related to autism; provide for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406s.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2011-01-19 - Referred To Committee On Insurance [SB0038 Detail]
Download: Michigan-2011-SB0038-Introduced.html
SENATE BILL No. 38
January 19, 2011, Introduced by Senators HUNTER, GLEASON, HOOD and WHITMER and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406s.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406s. (1) An expense-incurred hospital, medical, or
surgical group certificate delivered, issued for delivery, or
renewed in this state and a health maintenance organization group
contract shall provide coverage for the diagnosis and treatment of
autism spectrum disorders. An insurer and a health maintenance
organization shall not terminate coverage or refuse to deliver,
execute, issue, amend, adjust, or renew coverage solely because an
individual is diagnosed with, or has received treatment for, an
autism spectrum disorder.
(2) Coverage under this section is not subject to limits on
the number of visits an insured or enrollee may make to an autism
services provider.
(3) Except as provided in subsection (4), coverage under this
section shall not be subject to dollar limits, copays, deductibles,
or coinsurance provisions that do not apply to physical illness
generally.
(4) Coverage under this section for applied behavior analysis
may be subject to a maximum annual benefit of $50,000.00.
(5) This section shall not be construed as limiting benefits
that are otherwise available to an insured or enrollee under a
certificate.
(6) If an insured or enrollee is receiving treatment for
autism spectrum disorder, an insurer or health maintenance
organization may request a review of that treatment consistent with
current protocols and may require a treatment plan. The cost of
obtaining a treatment review shall be borne by the insurer or
health maintenance organization. An insurer or health maintenance
organization shall utilize evidence-based care and managed care
cost-containment practices in accordance with the insurer's or
health maintenance organization's procedures.
(7) This section does not apply to a short-term or 1-time
limited duration policy or certificate of no longer than 6 months
as defined in section 2213b.
(8) As used in this section:
(a) "Applied behavior analysis" means the design,
implementation, and evaluation of environmental modifications,
using behavioral stimuli and consequences, to produce significant
improvement in human behavior, including the use of direct
observation, measurement, and functional analysis of the relations
between environment and behavior.
(b) "Autism services provider" means a licensed physician, a
licensed psychologist, or a behavior analyst certified by the
behavior analyst certification board, or an individual supervised
by the physician, psychologist, or behavior analyst, who provides
treatment of autism spectrum disorders.
(c) "Autism spectrum disorder" means any of the following
pervasive developmental disorders:
(i) Autistic disorder.
(ii) Asperger's disorder.
(iii) Pervasive developmental disorder not otherwise specified.
(d) "Diagnosis of autism spectrum disorders" means
assessments, evaluations, or tests performed by a licensed
physician or a licensed psychologist to diagnose whether an
individual has 1 of the autism spectrum disorders.
(e) "Habilitative or rehabilitative care" means professional,
counseling, and guidance services and treatment programs, including
applied behavior analysis, that are necessary to develop, maintain,
and restore, to the maximum extent practicable, the functioning of
an individual.
(f) "Pharmacy care" means medications prescribed by a licensed
physician and related services performed by a licensed pharmacist
and any health-related services considered medically necessary to
determine the need or effectiveness of the medications.
(g) "Psychiatric care" means direct or consultative services
provided by a psychiatrist licensed in the state in which the
psychiatrist practices.
(h) "Psychological care" means direct or consultative services
provided by a psychologist licensed in the state in which the
psychologist practices.
(i) "Therapeutic care" means services provided by a licensed
or certified speech therapist, occupational therapist, physical
therapist, or social worker.
(j) "Treatment for autism spectrum disorders" means evidence-
based treatment that includes the following care prescribed,
provided, or ordered for an individual diagnosed with 1 of the
autism spectrum disorders by a licensed physician or a licensed
psychologist who determines the care to be medically necessary:
(i) Habilitative or rehabilitative care.
(ii) Pharmacy care.
(iii) Psychiatric care.
(iv) Psychological care.
(v) Therapeutic care.
(k) "Treatment plan" means a written comprehensive evaluation
by a multidisciplinary team, individualized for each patient and
developed by a licensed physician or licensed psychologist.
Enacting section 1. This amendatory act applies to policies,
certificates, and contracts delivered, executed, issued, amended,
adjusted, or renewed in this state, or outside this state if
covering residents of this state, beginning 180 days after the date
this amendatory act is enacted into law.
