HB 797 -- Insurance Coverage for Autism Spectrum Disorder

Sponsor:  Lampe

This bill requires all health carriers offering health benefit
plans which are delivered, issued, continued, or renewed on or
after August 28, 2009, to provide coverage for autism spectrum
disorder (ASD) with certain guidelines; however, the guidelines
will only be permitted if allowed under federal mental health
parity laws.  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
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 their expense unless the individual's treating
physician or psychologist agrees that a more frequent review is
necessary.

Applied behavior analysis treatments for individuals younger than
21 years of age must be covered by the health plan and 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 the percentage of
increase in the federal Consumer Price Index.

Any health carrier violating the provisions of the bill will be
subject to a fine enforceable by the department.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:25 am