S 363 Session 123 (2019-2020) S 0363 General Bill, By Davis, Senn, Shealy, Reese, Fanning, M.B.Matthews and McLeod A BILL TO AMEND SECTION 44-20-30 OF THE 1976 CODE, RELATING TO TERMS DEFINED IN THE "SOUTH CAROLINA INTELLECTUAL DISABILITY, RELATED DISABILITIES, HEAD INJURIES, AND SPINAL CORD INJURIES ACT," TO ADD A DEFINITION FOR "AUTISM SPECTRUM DISORDER"; AND TO AMEND SECTION 38-71-280 OF THE 1976 CODE, RELATING TO HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER, TO MAKE CONFORMING CHANGES.
TO AMEND SECTION 44-20-30 OF THE 1976 CODE, RELATING TO TERMS DEFINED IN THE "SOUTH CAROLINA INTELLECTUAL DISABILITY, RELATED DISABILITIES, HEAD INJURIES, AND SPINAL CORD INJURIES ACT," TO ADD A DEFINITION FOR "AUTISM SPECTRUM DISORDER"; AND TO AMEND SECTION 38-71-280 OF THE 1976 CODE, RELATING TO HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER, TO MAKE CONFORMING CHANGES. Be it enacted by the General Assembly of the State of South Carolina: SECTION 1. Section 44-20-30 of the 1976 Code is amended by adding an appropriately numbered new item 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 2. Section 38-71-280 of the 1976 Code is amended to read: "Section 38-71-280. (A) As used in this section:
(1) 'Autism spectrum disorder' means
(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) (3) 'Health maintenance organization' means an organization as defined in Section 38-33-20(8).
(4) 'Health insurance plan' means a (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 (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.
SECTION 3. This act takes effect upon approval by the Governor.
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