House Bill 542

AN ACT TO REQUIRE THAT THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN SHALL PROVIDE COVERAGE FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS; AND FOR RELATED PURPOSES.

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

SECTION 1. (1) Every health insurance policy shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. To the extent that the screening, diagnosis, and treatment of autism spectrum disorder are not already covered by a health insurance policy, coverage under this section shall be included in health insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state on or after July 1, 2014. No insurer may terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder.

(2) Coverage under this section shall not be subject to any limits on the number of visits an individual may make for treatment of autism spectrum disorder.

(3) Coverage under this section shall not be 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 substantially all medical and surgical benefits under the health insurance policy.

(4) This section shall not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(5) As used in this section the following terms shall have the following meanings, unless the context clearly indicates otherwise:

(a) "Applied behavior analysis" means the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement and functional analysis of the relationship between environment and behavior.

(b) "Autism spectrum disorder" means any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the time of diagnosis.

(c) "Diagnosis of autism spectrum disorder" means medically necessary assessment, evaluations or tests to diagnose whether an individual has an autism spectrum disorder.

(d) "Behavioral health treatment" means counseling and treatment programs, including applied behavior analysis, that are:

(i) Necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual; and

(ii) Provided or supervised by a Board Certified Behavior Analyst or by a licensed psychologist so long as the services performed are commensurate with the psychologist's formal university training and supervised experience.

(e) "Health insurance policy" means the State and School Employees Health Insurance Plan.

(f) "Pharmacy care" means medications prescribed by a licensed physician and any health-related services deemed 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 licensed or certified speech therapists, occupational therapists or physical therapists.

(j) "Treatment for autism spectrum disorder" means evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including, but not limited to:

(i) Behavioral health treatment;

(ii) Pharmacy care;

(iii) Psychiatric care;

(iv) Psychological care; and

(v) Therapeutic care.

(6) Coverage for applied behavior analysis shall include the services of the personnel who work under the supervision of the Board Certified Behavior Analyst or the licensed psychologist overseeing the program.

(7) Except for inpatient services, if an insured is receiving treatment for an autism spectrum disorder, an insurer shall have the right to review the treatment plan annually, unless the insurer and the insured's treating physician or psychologist agree that a more frequent review is necessary. Any such agreement regarding the right to review a treatment plan more frequently shall apply only to a particular insured being treated for an autism spectrum disorder and shall not apply to all individuals being treated for autism spectrum disorder by a physician or psychologist. The cost of obtaining any review or treatment plan shall be borne by the insurer.

(8) This section shall not be construed as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program or an individualized service plan.

(9) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, qualified health plans as defined in Section 1301 of the Patient Protection and Affordable Care Act, Medicare supplement, disability income, long-term care or other limited benefit hospital insurance policies.

(10) (a) By February 1, 2016, and every February 1 thereafter, the Mississippi Department of Insurance shall submit a report to the Legislature regarding the implementation of the coverage required under this section. The report shall include, but shall not be limited to, the following:

(i) The total number of insureds diagnosed with autism spectrum disorder;

(ii) The total cost of all claims paid out in the immediately preceding calendar year for coverage required by this section;

(iii) The cost of such coverage per insured per month; and

(iv) The average cost per insured for coverage of applied behavior analysis.

(b) All health carriers and health benefit plans subject to the provisions of this section shall provide the department with the data requested by the department for inclusion in the annual report.

SECTION 2. This act shall take effect and be in force from and after July 1, 2014.