SB1263 - 482R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-826.04, to read:

START_STATUTE20-826.04. Subscription contracts; autism spectrum disorder; coverage; exception; definitions

A. Any subscription contract that is offered by a hospital service corporation or medical service corporation shall provide coverage for the diagnosis and treatment of autism spectrum disorder. Coverage required by this section includes evaluation for a diagnosis of autism spectrum disorder that is provided by a medical doctor or a person licensed pursuant to title 32, chapter 19.1 and is limited to treatment, including speech therapy, occupational therapy, physical therapy, behavioral therapy, psychiatric care and psychological care, that is prescribed by the insured's treating medical doctor pursuant to a treatment plan. A corporation may not deny or refuse to issue coverage on, refuse to contract with, refuse to renew coverage on, refuse to reissue coverage for or otherwise terminate or restrict coverage on an individual solely because the individual is diagnosed with autism spectrum disorder.

B. The coverage required by this section is not subject to dollar limits, deductibles or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles or coinsurance provisions that apply to physical illness generally under the subscription contract, except as provided by subsection d. Benefits that are provided to an insured for any care, treatment, intervention, service or other item unrelated to autism spectrum disorder may not be applied towards any maximum benefit under this section. The coverage required by this section may be subject to other general exclusions and limitations of the subscription contract, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, case management and other managed care provisions. Treatment may not be limited or denied on the basis that it is habilitative in nature.

C. The treatment plan required pursuant to this section shall include all elements necessary for the corporation to appropriately pay claims. These elements include a diagnosis, the proposed treatment by type, the frequency and duration of treatment, the anticipated outcomes stated as goals, the frequency by which the treatment plan will be updated and the treating medical doctor's signature. The corporation may request an updated treatment plan only once every six months from the treating medical doctor, unless the corporation and the treating medical doctor agree that a more frequent review is necessary due to emerging clinical circumstances.

D. The benefits and coverage provided pursuant to this section must be provided to any eligible person who is under eighteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year, but may not be subject to any limits on the number of visits an eligible person may make to a provider of behavioral therapy. Beginning January 1, 2009, the corporation shall adjust this maximum benefit amount annually on January 1 of each calendar year to reflect any percentage change from the previous year in the medical price index component of the consumer price index for all urban consumers as published by the united states department of labor, bureau of labor statistics.

E. This section does not apply to a subscription contract that is issued to an individual or a small employer.

F. For the purposes of this section:

1. "Autism spectrum disorder" means one of the three following disorders as defined in the most recent edition of the diagnostic and statistical manual of mental disorders of the American psychiatric association:

(a) Autistic disorder.

(b) Asperger's syndrome.

2. "Behavioral therapy" includes interactive therapies derived from evidenced based research, including applied behavior analysis, which is also known as lovaas therapy, discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.

3. "Medical doctor" means a physician who is licensed pursuant to title 32, chapter 13 or 17.

4. "Small employer" has the same meaning prescribed in section 20‑2301. END_STATUTE

Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.11, to read:

START_STATUTE20-1057.11. Health care services organizations; autism spectrum disorder; coverage; exception; definitions

A. Each health care services organization shall provide evidence of coverage for the diagnosis and treatment of autism spectrum disorder. Coverage required by this section includes evaluation for a diagnosis of autism spectrum disorder that is provided by a medical doctor or a person licensed pursuant to title 32, chapter 19.1 and is limited to treatment, including speech therapy, occupational therapy, physical therapy, behavioral therapy, psychiatric care and psychological care, that is prescribed by the insured's treating medical doctor pursuant to a treatment plan. A health care services organization may not deny or refuse to issue coverage on, refuse to contract with, refuse to renew coverage on, refuse to reissue coverage for or otherwise terminate or restrict coverage on an individual solely because the individual is diagnosed with autism spectrum disorder.

B. The coverage required by this section is not subject to dollar limits, deductibles or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles or coinsurance provisions that apply to physical illness generally under the coverage, except as provided by subsection D Benefits that are provided to an insured for any care, treatment, intervention, service or other item unrelated to autism spectrum disorder may not be applied towards any maximum benefit under this section. The coverage required by this section may be subject to other general exclusions and limitations of the evidence of coverage, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, case management and other managed care provisions. Treatment may not be limited or denied on the basis that it is habilitative in nature.

C. The treatment plan required pursuant to this section shall include all elements necessary for the health care services organization to appropriately pay claims. These elements include a diagnosis, the proposed treatment by type, the frequency and duration of treatment, the anticipated outcomes stated as goals, the frequency by which the treatment plan will be updated and the treating medical doctor's signature. The health care services organization may request an updated treatment plan only once every six months from the treating medical doctor, unless the health care services organization and the treating medical doctor agree that a more frequent review is necessary due to emerging clinical circumstances.

D. The benefits and coverage provided pursuant to this section must be provided to any eligible person who is under eighteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year, but may not be subject to any limits on the number of visits an eligible person may make to a provider of behavioral therapy. Beginning January 1, 2009, the health care services organization shall adjust this maximum benefit amount annually on January 1 of each calendar year to reflect any percentage change from the previous year in the medical price index component of the consumer price index for all urban consumers as published by the united states department of labor, bureau of labor statistics.

E. This section does not apply to an evidence of coverage that is issued to an individual or a small employer.

F. For the purposes of this section:

(a) Autistic disorder.

(b) Asperger's syndrome.

3. "Medical doctor" means a physician who is licensed pursuant to title 32, chapter 13 or 17.

4. "Small employer" has the same meaning prescribed in section 20‑2301. END_STATUTE

Sec. 3. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding sections 20-1402.03 and 20-1404.03, to read:

START_STATUTE20-1402.03. Group disability insurers; autism spectrum disorder; coverage; definitions

A. A group disability insurer shall provide coverage for the diagnosis and treatment of autism spectrum disorder. Coverage required by this section includes evaluation for a diagnosis of autism spectrum disorder that is provided by a medical doctor or a person licensed pursuant to title 32, chapter 19.1 and is limited to treatment, including speech therapy, occupational therapy, physical therapy, behavioral therapy, psychiatric care and psychological care, that is prescribed by the insured's treating medical doctor pursuant to a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, refuse to renew coverage on, refuse to reissue coverage for or otherwise terminate or restrict coverage on an individual solely because the individual is diagnosed with autism spectrum disorder.

B. The coverage required by this section is not subject to dollar limits, deductibles or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles or coinsurance provisions that apply to physical illness generally under the policy, except as provided by subsection D. Benefits that are provided to an insured for any care, treatment, intervention, service or other item unrelated to autism spectrum disorder may not be applied towards any maximum benefit under this section. The coverage required by this section may be subject to other general exclusions and limitations of the policy, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, case management and other managed care provisions. Treatment may not be limited or denied on the basis that it is habilitative in nature.

C. The treatment plan required pursuant to this section shall include all elements necessary for the insurer to appropriately pay claims. These elements include a diagnosis, the proposed treatment by type, the frequency and duration of treatment, the anticipated outcomes stated as goals, the frequency by which the treatment plan will be updated and the treating medical doctor's signature. The insurer may request an updated treatment plan only once every six months from the treating medical doctor, unless the insurer and the treating medical doctor agree that a more frequent review is necessary due to emerging clinical circumstances.

D. The benefits and coverage provided pursuant to this section must be provided to any eligible person who is under eighteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year, but may not be subject to any limits on the number of visits an eligible person may make to a provider of behavioral therapy. Beginning January 1, 2009, the insurer shall adjust this maximum benefit amount annually on January 1 of each calendar year to reflect any percentage change from the previous year in the medical price index component of the consumer price index for all urban consumers as published by the united states department of labor, bureau of labor statistics.

E. For the purposes of this section:

(a) Autistic disorder.

(b) Asperger's syndrome.

3. "Medical doctor" means a physician who is licensed pursuant to title 32, chapter 13 or 17.

4. "Small employer" has the same meaning prescribed in section 20‑2301. END_STATUTE

START_STATUTE20-1404.03. Blanket disability insurers; autism spectrum disorder; coverage; definitions

A. A blanket disability insurer shall provide coverage for the diagnosis and treatment of autism spectrum disorder. Coverage required by this section includes evaluation for a diagnosis of autism spectrum disorder that is provided by a medical doctor or a person licensed pursuant to title 32, chapter 19.1 and is limited to treatment, including speech therapy, occupational therapy, physical therapy, behavioral therapy, psychiatric care and psychological care, that is prescribed by the insured's treating medical doctor pursuant to a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, refuse to renew coverage on, refuse to reissue coverage for or otherwise terminate or restrict coverage on an individual solely because the individual is diagnosed with autism spectrum disorder.

B. The coverage required by this section is not subject to dollar limits, deductibles or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles or coinsurance provisions that apply to physical illness generally under the policy or contract, except as provided by subsection D. Benefits that are provided to an insured for any care, treatment, intervention, service or other item unrelated to autism spectrum disorder may not be applied towards any maximum benefit under this section. The coverage required by this section may be subject to other general exclusions and limitations of the policy or contract, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, case management and other managed care provisions. Treatment may not be limited or denied on the basis that it is habilitative in nature.

D. The benefits and coverage provided pursuant to this section must be provided to any eligible person who is under eighteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year, but may not be subject to any limits on the number of visits an eligible person may make to a provider of behavioral therapy. Beginning January 1, 2009, the insurer shall adjust this maximum benefit amount annually on January 1 of each calendar year to reflect any percentage change from the previous year in the medical price index component of the consumer price index for all urban consumers as published by the united states department of labor, bureau of labor statistics.

E. For the purposes of this section:

(a) Autistic disorder.

(b) Asperger's syndrome.

3. "Medical doctor" means a physician who is licensed pursuant to title 32, chapter 13 or 17.

4. "Small employer" has the same meaning prescribed in section 20‑2301. END_STATUTE

Sec. 4. Short title

This act shall be known as "Steven's Law".

Sec. 5. Applicability

This act applies to contracts, policies and evidences of coverage issued or renewed from and after June 30, 2009.