HB 357 -- Insurance Coverage for Autism Spectrum Disorders

Sponsor:  Scharnhorst

Beginning August 28, 2009, this bill requires health carriers
issuing or renewing a health plan to provide individuals younger
than 21 years of age insurance coverage for the diagnosis and
treatment of autism spectrum disorders (ASD).  Carriers cannot
deny or refuse to issue insurance coverage on; refuse to contract
with; or refuse to renew or reissue, terminate, or restrict
coverage on an individual or his or her dependent solely because
of being diagnosed with ASD.  The coverage provided by an
insurance carrier for ASD is limited to the treatment ordered by
the insured individual's licensed treating physician or
psychologist in accordance with a treatment plan.  Except for
inpatient services, the health benefit plan or carrier can
request a review of the treatment not more than once every six
months at its expense unless the individual's treating physician
or psychologist agrees that a more frequent review is necessary.

Individual coverage for the applied behavior analysis will have a
maximum benefit of $72,000 per year with no limit on the number
of times an individual visits an autism service provider.  After
December 31, 2010, the Director of the Department of Insurance,
Financial Institutions and Professional Registration must
annually adjust the maximum benefit based upon inflation using
the federal Consumer Price Index.

Payments made by a health carrier for health services unrelated
to ASD for an individual with ASD cannot be applied toward the
ASD maximum benefit.  ASD services cannot be subject to any
greater deductible, co-insurance, or co-payment than other
physical health care services provided by the health benefit
plan.  Payments and reimbursements for applied behavior analysis
services provided by a person performing diagnostic or treatment
services for ASD, known as a direct implementer, must be made to
a person who supervises the direct implementer who is certified
by the Behavior Analyst Certification Board within the National
Commission for Certifying Agencies or an entity or group for whom
the supervising person works or is associated.

Individually sold health benefit plans and certain other
supplemental insurance policies are not subject to ASD coverage
requirements.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:24 am