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COMMITTEE REPORT
May 23, 2007
S. 20
Introduced by Senators Elliott, Mescher, Cleary, Hutto, Lourie, Moore, Sheheen, Reese, Knotts, Leventis, Land, McGill, Rankin, Campsen, Grooms, Hawkins, Short and Scott
S. Printed 5/23/07--H.
Read the first time May 1, 2007.
To whom was referred a Bill (S. 20) to amend the Code of Laws of South Carolina, 1976, by adding Section 38-71-280 so as to require insurance coverage for treatment of pervasive developmental disorders, etc., respectfully
That they have duly and carefully considered the same and recommend that the same do pass:
HARRY F. CATO for Committee.
EXPLANATION OF IMPACT:
Budget and Control Board
A review of the amendment indicates there would be an impact on the plan's expenditures which is estimated at $10.595 million annually. Since the bill is not specific as to whether the employer and/or employee premiums will be increased, it is assumed for this impact statement that the employer's contribution will be increased to absorb the cost of this benefit. Therefore, of the $10.595 million there will be an annual cost to the General Fund of the State of $6.57 million. The remaining $4.03 million represents an additional cost of federal and/or other funds to state agencies, school districts and other entities.
Department of Insurance
The department indicates that this bill would require one-time additional expenses totaling $30,000 for temporary or contract help to review all applicable policy forms for a year.
SPECIAL NOTES:
The italicized portion for this impact indicates the items that have been revised. For this impact, the revised constitutes information that was not available in the original impact.
Approved By:
Harry Bell
Office of State Budget
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-280 SO AS TO REQUIRE INSURANCE COVERAGE FOR TREATMENT OF PERVASIVE DEVELOPMENTAL DISORDERS AND TO DEFINE "PERVASIVE DEVELOPMENTAL DISORDER" AS A NEUROLOGICAL CONDITION, INCLUDING AUTISM AND ASPERGER'S SYNDROME.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding:
"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.
(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."
SECTION 2. This act takes effect July 1, 2008, and applies to health insurance plans issued, renewed, delivered, or entered into on or after this act's effective date.
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