S 0135 General Bill, By Cleary, Campbell, Verdin, Shealy, Fair, Lourie, Young, 
Corbin, S. Martin and Allen

Similar(H 5055)
 A BILL TO AMEND SECTION 38-71-280, CODE OF LAWS OF SOUTH CAROLINA, 1976,
 RELATING TO HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER, SO AS TO
 REVISE RELATED DEFINITIONS, TO DELETE EXISTING ELIGIBILITY REQUIREMENTS, AND
 TO PROVIDE A CITATION TO THE SECTION AS BEING "RYAN'S LAW".

   12/03/14  Senate Prefiled
   12/03/14  Senate Referred to Committee on Banking and Insurance
   01/13/15  Senate Introduced and read first time (Senate Journal-page 94)
   01/13/15  Senate Referred to Committee on Banking and Insurance
                     (Senate Journal-page 94)
   04/23/15  Senate Committee report: Favorable Banking and Insurance
                     (Senate Journal-page 11)
   04/29/15  Senate Read second time (Senate Journal-page 61)
   04/29/15  Senate Roll call Ayes-42  Nays-3 (Senate Journal-page 61)
   04/30/15  Senate Read third time and sent to House
                     (Senate Journal-page 11)
   05/05/15  House  Introduced and read first time (House Journal-page 15)
   05/05/15  House  Referred to Committee on Labor, Commerce and
                     Industry (House Journal-page 15)
   01/21/16  House  Recalled from Committee on Labor, Commerce and
                     Industry (House Journal-page 13)
   01/21/16  House  Committed to Committee on Ways and Means
                     (House Journal-page 13)

Indicates Matter Stricken

Indicates New Matter

COMMITTEE REPORT

April 23, 2015

S. 135

Introduced by Senators Cleary, Campbell, Verdin, Shealy, Fair, Lourie, Young, Corbin and S. Martin

S. Printed 4/23/15--S.

Read the first time January 13, 2015.

To whom was referred a Bill (S. 135) to amend Section 38-71-280, Code of Laws of South Carolina, 1976, relating to health insurance coverage for autism spectrum disorder, so as to revise related, etc., respectfully

That they have duly and carefully considered the same and recommend that the same do pass:

ROBERT W. HAYES, JR. for Committee.

TO AMEND SECTION 38-71-280, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER, SO AS TO REVISE RELATED DEFINITIONS, TO DELETE EXISTING ELIGIBILITY REQUIREMENTS, AND TO PROVIDE A CITATION TO THE SECTION AS BEING "RYAN'S LAW".

Be it enacted by the General Assembly of the State of South Carolina:

SECTION    1.    Section 38-71-280 of the 1976 Code, as added by Act 65 of 2007, is amended to read:

"Section 38-71-280.    (A)    As used in this section:

(1)    'Autism spectrum disorder' means one of the three following disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association:

(a)    Autistic Disorder;

(b)    Asperger's Syndrome;

(c)    Pervasive Developmental Disorder--Not Otherwise Specified any of the pervasive development disorders or autism spectrum disorders as defined by the most recent addition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the edition in effect at the time of diagnosis.

(2)    'Insurer' means an insurance company, a health maintenance organization, and any other entity providing health insurance coverage, as defined in Section 38-71-670(6), which is licensed to engage in the business of insurance in this State and which is subject to state insurance regulation.

(3)    'Health maintenance organization' means an organization as defined in Section 38-33-20(8).

(4)    'Health insurance plan' means a group health insurance policy or group health benefit plan offered by an insurer. It includes the State Health Plan, but does not otherwise include any health insurance plan offered in the individual market as defined in Section 38-71-670(11), any health insurance plan that is individually underwritten, or any health insurance plan provided to a small employer, as defined by Section 38-71-1330(17) of the 1976 Code.

(5)    'State Health Plan' means the employee and retiree insurance program provided for in Article 5, Chapter 11, Title 1.

(B)    A health insurance plan as defined in this section must provide coverage for the treatment of autism spectrum disorder. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating medical doctor in accordance with a treatment plan. With regards to a health insurance plan as defined in this section an insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew or refuse to reissue or otherwise terminate or restrict coverage on an individual solely because the individual is diagnosed with autism spectrum disorder.

(C)    The coverage required pursuant to subsection (B) must not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the health insurance plan, except as otherwise provided for in subsection (E). However, the coverage required pursuant to subsection (B) may be subject to other general exclusions and limitations of the health insurance plan, including, but not limited to, coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services including review of medical necessity, case management, and other managed care provisions.

(D)    The treatment plan required pursuant to subsection (B) must include all elements necessary for the health insurance plan to appropriately pay claims. These elements include, but are not limited to, a diagnosis, proposed treatment by type, frequency, and duration of treatment, the anticipated outcomes stated as goals, the frequency by which the treatment plan will be updated, and the treating medical doctor's signature. The health insurance plan may only request an updated treatment plan once every six months from the treating medical doctor to review medical necessity, unless the health insurance plan and the treating medical doctor agree that a more frequent review is necessary due to emerging clinical circumstances.

(E)    To be eligible for benefits and coverage under this section, an individual must be diagnosed with autistic spectrum disorder at age eight or younger. The benefits and coverage provided pursuant to this section must be provided to any eligible person under sixteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year. Beginning one year after the effective date of this act, this maximum benefit shall be adjusted annually on January 1 of each calendar year to reflect any change from the previous year in the current Consumer Price Index, All Urban Consumers, as published by the United States Department of Labor's Bureau of Labor Statistics This section must be known and may be cited as 'Ryan's Law'."

SECTION    2.    This act takes effect upon approval by the Governor.