Reference is to Printer's Date 3/29/17--H.
Amend the bill, as and if amended, by deleting all after the enacting words and inserting:
/ SECTION 1. This act must be known and may be cited as "Ryan's Law".
SECTION 2. Section 44-20-30 of the 1976 Code, as last amended by Act 47 of 2011, is further amended by adding an appropriately numbered item at the end to read:
"( ) 'Autism spectrum disorder' means autism spectrum disorder as defined by the most recent publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or a pervasive developmental disorder as defined in any previous edition of the DSM."
SECTION 3. Section 38-71-280 of the 1976 Code is amended to read:
"(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 autism spectrum disorder as defined by the
most recent publication of the Diagnostic and Statistical Manual
of Mental Disorders (DSM) or a pervasive developmental disorder
as defined in any previous edition of the DSM.
(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).
(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 first 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."
SECTION 4. This act takes effect upon approval by the Governor. /
Renumber sections to conform.
Amend title to conform.