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House Engrossed |
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State of Arizona House of Representatives Forty-eighth Legislature Second Regular Session 2008
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CHAPTER 4
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HOUSE BILL 2847 |
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AN ACT
Amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-826.04; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding sections 20-1402.03 and 20-1404.03; relating to autism spectrum disorder.
(TEXT OF BILL BEGINS ON NEXT PAGE)
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:
20-826.04. Subscription contracts; autism spectrum disorder; coverage; exceptions; definitions
A. A hospital service corporation or medical service corporation shall not:
1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, assessment and services.
2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage, behavioral therapy services shall be provided or supervised by a licensed or certified provider.
B. This section does not:
1. Apply to a subscription contract that is issued to an individual or a small employer.
2. Apply to limited benefit coverage as defined in section 20-1137.
3. Require coverage for services provided outside of this state.
C. The coverage required by this section is subject to all the terms and conditions of the subscription contract. Nothing in this section prevents a corporation from imposing deductibles, coinsurance or other cost sharing in relation to the coverage required by this section.
D. Coverage for behavioral therapy is subject to:
1. A fifty thousand dollar maximum benefit per year for an eligible person up to the age of nine.
2. A twenty-five thousand dollar maximum benefit per year for an eligible person who is between the ages of nine and sixteen.
E. 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.
(c) Pervasive developmental disorder – not otherwise specified.
2. "Behavioral therapy" means interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.
3. "small employer" has the same meaning prescribed in section 20‑2301.
Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.11, to read:
20-1057.11. Health care services organizations; autism spectrum disorder; coverage; exceptions; definitions
A. A health care services organization shall not:
1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, assessment and services.
2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage, behavioral therapy services shall be provided or supervised by a licensed or certified provider.
B. This section does not:
1. Apply to an evidence of coverage that is issued to an individual or a small employer.
2. Apply to limited benefit coverage as defined in section 20-1137.
3. Require coverage for services provided outside of this state.
C. The coverage required by this section is subject to all the terms and conditions of the evidence of coverage. Nothing in this section prevents an organization from imposing deductibles, coinsurance or other cost sharing in relation to the coverage required by this section.
D. Coverage for behavioral therapy is subject to:
1. A fifty thousand dollar maximum benefit per year for an eligible person up to the age of nine.
2. A twenty-five thousand dollar maximum benefit per year for an eligible person who is between the ages of nine and sixteen.
E. 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.
(c) Pervasive developmental disorder – not otherwise specified.
2. "Behavioral therapy" means interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.
3. "small employer" has the same meaning prescribed in section 20‑2301.
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:
20-1402.03. Group disability insurers; autism spectrum disorder; coverage; exceptions; definitions
A. A group disability insurer shall not:
1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, assessment and services.
2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage, behavioral therapy services shall be provided or supervised by a licensed or certified provider.
B. This section does not:
1. Apply to a policy that is issued to an individual or a small employer.
2. Apply to long term care insurance, life insurance, annuities and limited benefit coverage as defined in section 20-1137.
3. Require coverage for services provided outside of this state.
C. The coverage required by this section is subject to all the terms and conditions of the group disability contract. Nothing in this section prevents a group disability insurer from imposing deductibles, coinsurance or other cost sharing in relation to the coverage required by this section.
D. Coverage for behavioral therapy is subject to:
1. A fifty thousand dollar maximum benefit per year for an eligible person up to the age of nine.
2. A twenty-five thousand dollar maximum benefit per year for an eligible person who is between the ages of nine and sixteen.
E. 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.
(c) Pervasive developmental disorder – not otherwise specified.
2. "Behavioral therapy" means interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.
3. "Small employer" has the same meaning prescribed in section 20‑2301.
20-1404.03. Blanket disability insurers; autism spectrum disorder; coverage; exceptions; definitions
A. A blanket disability insurer shall not:
1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, assessment and services.
2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage, behavioral therapy services shall be provided or supervised by a licensed or certified provider.
B. This section does not:
1. Apply to a policy or contract that is issued to an individual or a small employer.
2. Apply to limited benefit coverage as defined in section 20-1137.
3. Require coverage for services provided outside of this state.
C. The coverage required by this section is subject to all the terms and conditions of the blanket disability contract. Nothing in this section prevents a blanket disability insurer from imposing deductibles, coinsurance or other cost sharing in relation to the coverage required by this section.
D. Coverage for behavioral therapy is subject to:
1. A fifty thousand dollar maximum benefit per year for an eligible person up to the age of nine.
2. A twenty-five thousand dollar maximum benefit per year for an eligible person who is between the ages of nine and sixteen.
E. 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.
(c) Pervasive developmental disorder – not otherwise specified.
2. "Behavioral therapy" means interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.
3. "Small employer" has the same meaning prescribed in section 20‑2301.
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.
APPROVED BY THE GOVERNOR MARCH 21, 2008.
FILED IN THE OFFICE OF THE SECRETARY OF STATE MARCH 21, 2008.