HB 1311 -- Health Insurance Coverage for Autism Spectrum
Disorders

Sponsor:  Scharnhorst

This bill requires all health benefit plans that are delivered,
issued, continued, or renewed on or after August 28, 2010, to
provide 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 or because he or she receives coverage.  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.  Service exclusions contained in an insurance policy or
health maintenance organization contract that are inconsistent
with an ASD treatment plan will be considered invalid as to ASD.
An ASD treatment plan must include all elements necessary for a
health carrier to review the plan when requested.  Except for
inpatient services, the health benefit plan or carrier can
request, at its expense, a review of the treatment plan not more
than once every six months unless the individual's treating
physician or psychologist agrees that a more frequent review is
necessary.

Coverage for individuals younger than 21 years of age for the
applied behavior analysis (ABA) services will have a maximum
benefit of $72,000 per year with no limit on the number of visits
to an autism service provider.  Coverage cannot be denied on the
basis that it is educational or habilitative in nature.

Payments and reimbursements for ABA services can only be made to
the ASD service provider, the certified supervisor of the
provider, or the entity or group for whom the supervisor works or
is associated.  ASD services cannot be subject to any greater
deductible, co-insurance, co-payment, or utilization review than
other physical health care services provided by the health
benefit plan.  Health carriers and benefit plans are not required
to reimburse a school district for ASD services that it provided.

Health benefit plans established, extended, modified, or renewed
on or after August 28, 2010, under the Missouri Consolidated
Health Care Plan, self-insured governmental plans, self-insured
group arrangements, multiple employer welfare arrangements, and
self-insured school district health plans must offer individual
ASD coverage.  Individually sold health benefit plans must offer
ASD coverage as an option to any plan.  Certain supplemental
insurance policies are exempt from the provisions of the bill.

The Director of the Department of Insurance, Financial
Institutions and Professional Registration must grant a small
employer that offers a group health plan a waiver from offering
ASD coverage to the group health plan if the employer
demonstrates by actual experience over any consecutive 24-month
period that the cost of providing the ASD coverage has resulted
in a 5% increase in the health plan premiums over a calendar
year.

The provisions of the bill do not apply to the MO HealthNet
Program or any program administered or sponsored by the MO
HealthNet Division within the Department of Social Services.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:10 pm