October 20, 2020
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       Florida Senate - 2010                              CS for SB 214
       
       
       
       By the Committee on Health Regulation; and Senator Ring
       
       
       
       
       588-02715A-10                                          2010214c1
    1                        A bill to be entitled                      
    2         An act relating to autism; creating s. 381.986, F.S.;
    3         requiring that a physician refer a minor to an
    4         appropriate specialist for screening for autism
    5         spectrum disorder under certain circumstances;
    6         defining the term “appropriate specialist”; amending
    7         ss. 627.6686 and 641.31098, F.S.; defining the terms
    8         “developmental disability” and “direct patient
    9         access”; providing health insurance coverage for
   10         individuals with certain developmental disabilities;
   11         requiring certain insurers and health maintenance
   12         organizations to provide direct patient access to an
   13         appropriate specialist for screening, evaluation of,
   14         or diagnosis for autism spectrum disorder or other
   15         developmental disabilities; requiring the insurer’s
   16         policy or the health maintenance organization’s
   17         contract to provide a minimum number of visits per
   18         year for the screening, evaluation, or diagnosis for
   19         autism spectrum disorder or other developmental
   20         disabilities; providing an effective date.
   21  
   22  Be It Enacted by the Legislature of the State of Florida:
   23  
   24         Section 1. Section 381.986, Florida Statutes, is created to
   25  read:
   26         381.986Screening for autism spectrum disorder.—
   27         (1) If the parent or legal guardian of a minor believes
   28  that the minor exhibits symptoms of autism spectrum disorder,
   29  the parent or legal guardian may report his or her observation
   30  to a physician licensed in this state. The physician shall
   31  perform screening in accordance with American Academy of
   32  Pediatrics’ guidelines. If the physician determines that
   33  referral to a specialist is medically necessary, he or she shall
   34  refer the minor to an appropriate specialist to determine
   35  whether the minor meets diagnostic criteria for autism spectrum
   36  disorder. If the physician determines that referral to a
   37  specialist is not medically necessary, the physician shall
   38  inform the parent or legal guardian that they can self-refer to
   39  the Early Steps intervention program or other specialist in
   40  autism. This section does not apply to a physician providing
   41  care under s. 395.1041.
   42         (2) As used in this section, the term “appropriate
   43  specialist” means a qualified professional who is experienced in
   44  the evaluation of autism spectrum disorder, is licensed in this
   45  state, and has training in validated diagnostic tools. The term
   46  includes, but is not limited to:
   47         (a) A psychologist;
   48         (b) A psychiatrist;
   49         (c) A neurologist;
   50         (d) A developmental or behavioral pediatrician; or
   51         (e) A professional whose licensure is deemed appropriate by
   52  the Children’s Medical Services Early Steps Program within the
   53  Department of Health.
   54         Section 2. Section 627.6686, Florida Statutes, is amended
   55  to read:
   56         627.6686 Coverage for individuals with developmental
   57  disabilities autism spectrum disorder required; exception.—
   58         (1) This section and s. 641.31098 may be cited as the
   59  “Steven A. Geller Autism Coverage Act.”
   60         (2) As used in this section, the term:
   61         (a) “Applied behavior analysis” means the design,
   62  implementation, and evaluation of environmental modifications,
   63  using behavioral stimuli and consequences, to produce socially
   64  significant improvement in human behavior, including, but not
   65  limited to, the use of direct observation, measurement, and
   66  functional analysis of the relations between environment and
   67  behavior.
   68         (b) “Autism spectrum disorder” means any of the following
   69  disorders as defined in the most recent edition of the
   70  Diagnostic and Statistical Manual of Mental Disorders of the
   71  American Psychiatric Association:
   72         1. Autistic disorder.
   73         2. Asperger’s syndrome.
   74         3. Pervasive developmental disorder not otherwise
   75  specified.
   76         (c) “Developmental disability” means a disorder or syndrome
   77  attributable to cerebral palsy or Down syndrome, which manifests
   78  before the age of 18 years and constitutes a substantial
   79  handicap that can reasonably be expected to continue
   80  indefinitely. As used in this section:
   81         1. “Cerebral palsy” has the same meaning as in s. 393.063.
   82         2. “Down syndrome” means a disorder caused by the presence
   83  of an extra chromosome 21.
   84         (d)“Direct patient access” means the ability of an insured
   85  to obtain services from an in-network provider without a
   86  referral or other authorization before receiving services.
   87         (e)(c) “Eligible individual” means an individual under 18
   88  years of age or an individual 18 years of age or older who is in
   89  high school and who has been diagnosed as having a developmental
   90  disability at 8 years of age or younger.
   91         (f)(d) “Health insurance plan” means a group health
   92  insurance policy or group health benefit plan offered by an
   93  insurer which includes the state group insurance program
   94  provided under s. 110.123. The term does not include a any
   95  health insurance plan offered in the individual market, a any
   96  health insurance plan that is individually underwritten, or a
   97  any health insurance plan provided to a small employer.
   98         (g)(e) “Insurer” means an insurer providing health
   99  insurance coverage, which is licensed to engage in the business
  100  of insurance in this state and is subject to insurance
  101  regulation.
  102         (3) A health insurance plan issued or renewed on or after
  103  April 1, 2009, shall provide coverage to an eligible individual
  104  for:
  105         (a) Direct patient access to an appropriate specialist, as
  106  defined in s. 381.986, for a minimum of three visits per policy
  107  year for the screening for, evaluation of, or diagnosis of
  108  autism spectrum disorder or other developmental disability.
  109         (b)(a) Well-baby and well-child screening for diagnosing
  110  the presence of autism spectrum disorder.
  111         (c)(b) Treatment of autism spectrum disorder or other
  112  developmental disability through speech therapy, occupational
  113  therapy, physical therapy, and applied behavior analysis.
  114  Applied behavior analysis services shall be provided by an
  115  individual certified pursuant to s. 393.17 or an individual
  116  licensed under chapter 490 or chapter 491.
  117         (4) The coverage required pursuant to subsection (3) is
  118  subject to the following requirements:
  119         (a) Coverage shall be limited to treatment that is
  120  prescribed by the insured’s treating physician in accordance
  121  with a treatment plan.
  122         (b) Coverage for the services described in subsection (3)
  123  shall be limited to $36,000 annually and may not exceed $200,000
  124  in total lifetime benefits.
  125         (c) Coverage may not be denied on the basis that provided
  126  services are habilitative in nature.
  127         (d) Coverage may be subject to other general exclusions and
  128  limitations of the insurer’s policy or plan, including, but not
  129  limited to, coordination of benefits, participating provider
  130  requirements, restrictions on services provided by family or
  131  household members, and utilization review of health care
  132  services, including the review of medical necessity, case
  133  management, and other managed care provisions.
  134         (5) The coverage required pursuant to subsection (3) may
  135  not be subject to dollar limits, deductibles, or coinsurance
  136  provisions that are less favorable to an insured than the dollar
  137  limits, deductibles, or coinsurance provisions that apply to
  138  physical illnesses that are generally covered under the health
  139  insurance plan, except as otherwise provided in subsection (4).
  140         (6) An insurer may not deny or refuse to issue coverage for
  141  medically necessary services, refuse to contract with, or refuse
  142  to renew or reissue or otherwise terminate or restrict coverage
  143  for an individual because the individual is diagnosed as having
  144  a developmental disability.
  145         (7) The treatment plan required pursuant to subsection (4)
  146  shall include all elements necessary for the health insurance
  147  plan to appropriately pay claims. These elements include, but
  148  are not limited to, a diagnosis, the proposed treatment by type,
  149  the frequency and duration of treatment, the anticipated
  150  outcomes stated as goals, the frequency with which the treatment
  151  plan will be updated, and the signature of the treating
  152  physician.
  153         (8) Beginning January 1, 2011, the maximum benefit under
  154  paragraph (4)(b) shall be adjusted annually on January 1 of each
  155  calendar year to reflect any change from the previous year in
  156  the medical component of the then current Consumer Price Index
  157  for all urban consumers, published by the Bureau of Labor
  158  Statistics of the United States Department of Labor.
  159         (9) This section may not be construed as limiting benefits
  160  and coverage otherwise available to an insured under a health
  161  insurance plan.
  162         (10) The Office of Insurance Regulation may not enforce
  163  this section against an insurer that is a signatory no later
  164  than April 1, 2009, to the developmental disabilities compact
  165  established under s. 624.916. The Office of Insurance Regulation
  166  shall enforce this section against an insurer that is a
  167  signatory to the compact established under s. 624.916 if the
  168  insurer has not complied with the terms of the compact for all
  169  health insurance plans by April 1, 2010.
  170         Section 3. Subsections (2) and (3) of section 641.31098,
  171  Florida Statutes, are amended to read:
  172         641.31098 Coverage for individuals with developmental
  173  disabilities.—
  174         (2) As used in this section, the term:
  175         (a) “Applied behavior analysis” means the design,
  176  implementation, and evaluation of environmental modifications,
  177  using behavioral stimuli and consequences, to produce socially
  178  significant improvement in human behavior, including, but not
  179  limited to, the use of direct observation, measurement, and
  180  functional analysis of the relations between environment and
  181  behavior.
  182         (b) “Autism spectrum disorder” means any of the following
  183  disorders as defined in the most recent edition of the
  184  Diagnostic and Statistical Manual of Mental Disorders of the
  185  American Psychiatric Association:
  186         1. Autistic disorder.
  187         2. Asperger’s syndrome.
  188         3. Pervasive developmental disorder not otherwise
  189  specified.
  190         (c) “Developmental disability” means a disorder or syndrome
  191  attributable to cerebral palsy or Down syndrome, which manifests
  192  before the age of 18 years and constitutes a substantial
  193  handicap that can reasonably be expected to continue
  194  indefinitely. As used in this section:
  195         1. “Cerebral palsy” has the same meaning as in s. 393.063.
  196         2. “Down syndrome” means a disorder caused by the presence
  197  of an extra chromosome 21.
  198         (d)“Direct patient access” means the ability of an insured
  199  to obtain services from an in-network provider without a
  200  referral or other authorization before receiving services.
  201         (e)(c) “Eligible individual” means an individual under 18
  202  years of age or an individual 18 years of age or older who is in
  203  high school and who has been diagnosed as having a developmental
  204  disability at 8 years of age or younger.
  205         (f)(d) “Health maintenance contract” means a group health
  206  maintenance contract offered by a health maintenance
  207  organization. The This term does not include a health
  208  maintenance contract offered in the individual market, a health
  209  maintenance contract that is individually underwritten, or a
  210  health maintenance contract provided to a small employer.
  211         (3) A health maintenance contract issued or renewed on or
  212  after April 1, 2009, shall provide coverage to an eligible
  213  individual for:
  214         (a) Direct patient access to an appropriate specialist, as
  215  defined in s. 381.986, for a minimum of three visits per policy
  216  year for the screening for, evaluation of, or diagnosis of
  217  autism spectrum disorder or other developmental disability.
  218         (b)(a) Well-baby and well-child screening for diagnosing
  219  the presence of autism spectrum disorder.
  220         (c)(b) Treatment of autism spectrum disorder or other
  221  developmental disability through speech therapy, occupational
  222  therapy, physical therapy, and applied behavior analysis
  223  services. Applied behavior analysis services shall be provided
  224  by an individual certified pursuant to s. 393.17 or an
  225  individual licensed under chapter 490 or chapter 491.
  226         Section 4. This act shall take effect July 1, 2010.

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