Bill Text: MI SB0039 | 2011-2012 | 96th Legislature | Introduced
Bill Title: Insurance; health care corporations; coverage for certain treatments related to autism; provide for. Amends 1980 PA 350 (MCL 550.1101 - 550.1704) by adding sec. 416e.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2011-01-19 - Referred To Committee On Insurance [SB0039 Detail]
Download: Michigan-2011-SB0039-Introduced.html
SENATE BILL No. 39
January 19, 2011, Introduced by Senators HUNTER, GLEASON, WHITMER and HOOD and referred to the Committee on Insurance.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
(MCL 550.1101 to 550.1704) by adding section 416e.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 416e. (1) A health care corporation group certificate
shall provide coverage for the diagnosis and treatment of autism
spectrum disorders.
(2) Coverage under this section is not subject to limits on
the number of visits a member 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 a member under a certificate.
(6) If a member is receiving treatment for autism spectrum
disorder, a health care corporation 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 health care corporation. A health care corporation
shall utilize evidence-based care and managed care cost-containment
practices in accordance with the health care corporation's
procedures.
(7) 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
certificates delivered, executed, issued, amended, adjusted, or
renewed in this state beginning 180 days after the date this
amendatory act is enacted into law.
