HCS SS SCS SB 167 -- INSURANCE COVERAGE FOR AUTISM SPECTRUM
DISORDERS

SPONSOR:  Rupp (Scharnhorst)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Health
Care Policy by a vote of 7 to 1.

Beginning January 1, 2010, this substitute requires health
carriers issuing or renewing a health plan to provide individuals
younger than 18 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 $36,000 per year for individuals younger than
15 years of age, and there is no maximum benefit limit for
individuals 15 years of age and older with no limit on the number
of times an individual visits an autism service provider.  After
December 31, 2010, and annually thereafter, the Director of the
Department of Insurance, Financial Institutions and Professional
Registration must adjust the maximum benefit for applied
behavioral analysis for inflation using the Medical Care
Component of the United States Department of Labor Consumer Price
Index for All Urban Consumers.

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 and 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.

Health care plans delivered, issued, continued, or renewed on or
after January 1, 2010, to employees and their dependents under
the Missouri Consolidated Health Care Plan, self-insured
governmental plans, self-insured group arrangements, plans
provided through a multiple employer welfare arrangement if
permitted by the federal Employee Retirement Income Security Act
of 1974, and self-insured school district health plans are
subject to ASD coverage requirements.  Individually sold health
benefit plans and certain other supplemental insurance policies
are not subject to ASD coverage requirements.

The substitute requires the department director to grant a waiver
from the mandated coverage for the diagnosis and treatment of ASD
if a group contract holder demonstrates to the department
director by actual experience over any consecutive 24-month
period that compliance with the provisions of the substitute has
increased the cost of the health insurance policy by an amount
that results in a 5% increase, over the period of a calendar
year, in the premium costs to the group contract holder.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
could exceed $1,965,780 in FY 2010, Unknown could exceed
$3,931,560 in FY 2011, and Unknown could exceed $3,931,560 in
FY 2012.  Estimated Cost on Other State Funds of Could exceed
$452,080 in FY 2010, Could exceed $904,160 in FY 2011, and Could
exceed $904,160 in FY 2012.

PROPONENTS:  Supporters say that the insurance mandate will only
result in a nominal increase in cost and will be less than not
covering a child with autism.  Autism is a neurobiological
disorder that responds well to treatment.

Testifying for the bill were Senator Rupp; Molly Schad; and
Judevine Center for Autism.

OPPONENTS:  Those who oppose the bill say that health insurance
costs will increase; only a small percentage of children will
actually be covered; and applied behavior analysis is considered
an educational intervention and, therefore, is not covered by
insurance policies.

Testifying against the bill were United Health Care; America's
Health Insurance Plans; Coventry Health Care; Anthem Blue Cross
and Blue Shield; Blue Cross Blue Shield of Kansas City; and
Missouri Insurance Coalition.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:26 am