HF 863

as introduced - 89th Legislature (2015 - 2016) Posted on 02/12/2015 02:34pm

A bill for an act
relating to insurance; modifying insurance coverage for autism spectrum
disorder; amending Minnesota Statutes 2014, section 62A.3094, subdivision 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 62A.3094, subdivision 2, is amended to
read:

Subd. 2.

Coverage required.

(a) A health plan deleted text begin issued to a large employer deleted text end , as
defined in section , subdivision deleted text begin 1 deleted text end new text begin 3 new text end , must provide coverage for the
diagnosis, evaluation, multidisciplinary assessment, and medically necessary care of
deleted text begin children deleted text end new text begin a child new text end under new text begin age new text end 18 with new text begin an new text end autism spectrum deleted text begin disorders deleted text end new text begin disorder new text end , including but
not limited to the following:

(1) early intensive behavioral and developmental therapy based in behavioral and
developmental science, including, but not limited to, all types of applied behavior analysis,
intensive early intervention behavior therapy, and intensive behavior intervention;

(2) neurodevelopmental and behavioral health treatments and management;

(3) speech therapy;

(4) occupational therapy;

(5) physical therapy; and

(6) medications.

(b) The diagnosis, evaluation, and assessment must include an assessment of the
child's developmental skills, functional behavior, needs, and capacities.

(c) The coverage required under this subdivision must include treatment that is in
accordance with an individualized treatment plan prescribed by the enrollee's treating
physician or mental health professional.

(d) A health carrier may not refuse to renew or reissue, or otherwise terminate or
restrict, coverage of an individual solely because the individual is diagnosed with an
autism spectrum disorder.

(e) A health carrier may request an updated treatment plan only once every six
months, unless the health carrier and the treating physician or mental health professional
agree that a more frequent review is necessary due to emerging circumstances.

(f) An independent progress evaluation conducted by a mental health professional
with expertise and training in autism spectrum disorder and child development must be
completed to determine if progress toward deleted text begin function deleted text end new text begin functional new text end and generalizable gains, as
determined in the treatment plan, is being made.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016, and applies to
coverage offered, sold, issued, or renewed on or after that date.
new text end