HB 1341 -- Health Insurance Coverage for Autism Spectrum
Disorders

Sponsor:  Grill

This bill requires all health benefit plans that are delivered,
issued, continued, or renewed on or after January 1, 2011, to
provide coverage for individuals 18 years of age or younger 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 and is limited to treatment and diagnosis provided within
Missouri.  An ASD treatment plan must include all elements
necessary for a health carrier to appropriately pay claims.
Except for inpatient services, the health 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 15 years of age for the
applied behavior analysis (ABA) services will have a maximum
benefit of $55,000 per year with no limit on the number of visits
to an autism service provider.  Individuals who are 15 years of
age or older will not be eligible for these services.  Coverage
cannot be denied on the basis that it is educational or
habilitative in nature.  After December 31, 2010, the Director of
the Department of Insurance, Financial Institutions and
Professional Registration must annually adjust the maximum
benefit for inflation based on the federal Consumer Price Index.

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 services delivered by an early
intervention or a school service.

Health benefit plans delivered, issued, continued, or renewed on
or after January 1, 2011, 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.

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