SF 312

2nd Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:12am

A bill for an act
relating to insurance; requiring coverage for autism spectrum disorders;
amending Minnesota Statutes 2008, section 256B.0625, by adding a subdivision;
proposing coding for new law in Minnesota Statutes, chapter 62A.

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

Section 1.

new text begin [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in
paragraphs (b) to (e) have the meanings given.
new text end

new text begin (b) "Autism spectrum disorders" means one or more of the following conditions as
determined by criteria set forth in the most recent edition of the Diagnostic and Statistical
Manual of Mental Disorders of the American Psychiatric Association:
new text end

new text begin (1) autism or autistic disorder;
new text end

new text begin (2) Asperger's syndrome; or
new text end

new text begin (3) pervasive developmental disorder - not otherwise specified.
new text end

new text begin (c) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
new text end

new text begin (d) "Medically necessary care" means health care services appropriate, in terms of
type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
testing and preventative services. Medically necessary care must be consistent with
generally accepted practice parameters as determined by physicians and licensed
psychologists who typically manage patients who have autism spectrum disorders.
new text end

new text begin (e) "Mental health professional" has the meaning given in section 245.4871,
subdivision 27.
new text end

new text begin Subd. 2. new text end

new text begin Coverage required. new text end

new text begin (a) A health plan must provide coverage for the
diagnosis, evaluation, assessment, and medically necessary care of autism spectrum
disorders, including but not limited to the following:
new text end

new text begin (1) intensive behavior therapy, such as applied behavior analysis, intensive early
intervention behavior therapy, intensive behavior intervention, and Lovaas therapy;
new text end

new text begin (2) behavior services, instruction, and management;
new text end

new text begin (3) speech therapy;
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new text begin (4) occupational therapy;
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new text begin (5) physical therapy; and
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new text begin (6) medications.
new text end

new text begin (b) Coverage required under this section shall include treatment that is in accordance
with an individualized treatment plan prescribed by the insured's treating physician or
mental health professional.
new text end

new text begin (c) A health plan 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.
new text end

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

new text begin Subd. 3. new text end

new text begin No effect on other law. new text end

new text begin Nothing in this section limits in any way the
coverage required under section 62Q.47.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2009, and applies to
coverage offered; issued; sold; renewed; or continued as defined in Minnesota Statutes,
section 60A.02, subdivision 2a; on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 53. new text end

new text begin Autism spectrum disorder. new text end

new text begin Medical assistance covers the services
required by section 62A.3094.
new text end