October 20, 2020
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       Florida Senate - 2010                CS for CS for CS for SB 214
       
       
       
       By the Committees on Governmental Oversight and Accountability;
       Banking and Insurance; and Health Regulation; and Senators Ring,
       Gardiner, and Fasano
       
       
       585-04285-10                                           2010214c3
    1                        A bill to be entitled                      
    2         An act relating to autism and other developmental
    3         disabilities; creating s. 381.986, F.S.; requiring
    4         that a physician refer a minor to an appropriate
    5         specialist for screening for autism spectrum disorder
    6         under certain circumstances; defining the term
    7         “appropriate specialist”; amending ss. 627.6686 and
    8         641.31098, F.S.; defining the terms “developmental
    9         disability” and “direct patient access”; providing
   10         health insurance coverage for individuals with certain
   11         developmental disabilities; requiring certain insurers
   12         and health maintenance organizations to provide direct
   13         patient access to an appropriate specialist for the
   14         screening, evaluation, or diagnosis of autism spectrum
   15         disorder or other developmental disabilities;
   16         requiring the insurer’s policy or the health
   17         maintenance organization’s contract to provide a
   18         minimum number of visits per year for the screening,
   19         evaluation, or diagnosis of autism spectrum disorder
   20         or other developmental disabilities; revising the
   21         effective dates of certain enforcement provisions;
   22         providing a declaration of important state interest;
   23         providing applicability; providing an effective date.
   24  
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Section 381.986, Florida Statutes, is created to
   28  read:
   29         381.986Screening for autism spectrum disorder.—
   30         (1) If the parent or legal guardian of a minor believes
   31  that the minor exhibits symptoms of autism spectrum disorder as
   32  defined in ss. 627.6686 and 641.31098, the parent or legal
   33  guardian may report his or her observation to a physician
   34  licensed in this state. The physician shall perform screening in
   35  accordance with American Academy of Pediatrics’ guidelines. If
   36  the physician determines that referral to a specialist is
   37  medically necessary, he or she shall refer the minor to an
   38  appropriate specialist to determine whether the minor meets
   39  diagnostic criteria for autism spectrum disorder as defined in
   40  ss. 627.6686 and 641.31098. If the physician determines that
   41  referral to a specialist is not medically necessary, the
   42  physician shall inform the parent or legal guardian that they
   43  can self-refer to the Early Steps intervention program or other
   44  specialist in autism. This section does not apply to a physician
   45  providing care under s. 395.1041.
   46         (2) As used in this section, the term “appropriate
   47  specialist” means a qualified professional who is experienced in
   48  the evaluation of autism spectrum disorder as defined in ss.
   49  627.6686 and 641.31098, is licensed in this state, and has
   50  training in validated diagnostic tools. The term includes, but
   51  is not limited to:
   52         (a) A psychologist;
   53         (b) A psychiatrist;
   54         (c) A neurologist;
   55         (d) A developmental or behavioral pediatrician; or
   56         (e) A professional whose licensure, by rule, is deemed
   57  appropriate by the Children’s Medical Services Early Steps
   58  Program within the Department of Health.
   59         Section 2. Section 627.6686, Florida Statutes, is amended
   60  to read:
   61         627.6686 Coverage for individuals with developmental
   62  disabilities autism spectrum disorder required; exception.—
   63         (1) This section and s. 641.31098 may be cited as the
   64  “Steven A. Geller Autism Coverage Act.”
   65         (2) As used in this section, the term:
   66         (a) “Applied behavior analysis” means the design,
   67  implementation, and evaluation of environmental modifications,
   68  using behavioral stimuli and consequences, to produce socially
   69  significant improvement in human behavior, including, but not
   70  limited to, the use of direct observation, measurement, and
   71  functional analysis of the relations between environment and
   72  behavior.
   73         (b) “Autism spectrum disorder” means any of the following
   74  disorders as defined in the most recent edition of the
   75  Diagnostic and Statistical Manual of Mental Disorders of the
   76  American Psychiatric Association:
   77         1. Autistic disorder.
   78         2. Asperger’s syndrome.
   79         3. Pervasive developmental disorder not otherwise
   80  specified.
   81         (c) “Developmental disability” means a disorder or syndrome
   82  attributable to cerebral palsy or Down syndrome, which manifests
   83  before the age of 18 years and constitutes a substantial
   84  handicap that can reasonably be expected to continue
   85  indefinitely. As used in this section:
   86         1. “Cerebral palsy” has the same meaning as in s. 393.063.
   87         2. “Down syndrome” means a disorder caused by the presence
   88  of an extra chromosome 21.
   89         (d)“Direct patient access” means the ability of an insured
   90  to obtain services from an in-network provider without a
   91  referral or other authorization before receiving services.
   92         (e)(c) “Eligible individual” means an individual under 18
   93  years of age or an individual 18 years of age or older who is in
   94  high school and who has been diagnosed as having a developmental
   95  disability at 8 years of age or younger.
   96         (f)(d) “Health insurance plan” means a group health
   97  insurance policy or group health benefit plan offered by an
   98  insurer which includes the state group insurance program
   99  provided under s. 110.123. The term does not include a any
  100  health insurance plan offered in the individual market, a any
  101  health insurance plan that is individually underwritten, or a
  102  any health insurance plan provided to a small employer.
  103         (g)(e) “Insurer” means an insurer providing health
  104  insurance coverage, which is licensed to engage in the business
  105  of insurance in this state and is subject to insurance
  106  regulation.
  107         (3) A health insurance plan must issued or renewed on or
  108  after April 1, 2009, shall provide coverage to an eligible
  109  individual for:
  110         (a) Direct patient access to one appropriate specialist, as
  111  defined in s. 381.986, for a minimum of three visits per policy
  112  year for the screening for, evaluation of, or diagnosis of
  113  autism spectrum disorder or other developmental disability.
  114         (b)(a) Well-baby and well-child screening for diagnosing
  115  the presence of autism spectrum disorder.
  116         (c)(b) Treatment of autism spectrum disorder or other
  117  developmental disability through speech therapy, occupational
  118  therapy, physical therapy, and applied behavior analysis.
  119  Applied behavior analysis services shall be provided by an
  120  individual certified pursuant to s. 393.17 or an individual
  121  licensed under chapter 490 or chapter 491.
  122         (4) The coverage required pursuant to subsection (3) is
  123  subject to the following requirements:
  124         (a) Coverage shall be limited to treatment that is
  125  prescribed by the insured’s treating physician in accordance
  126  with a treatment plan.
  127         (b) Coverage for the services described in subsection (3)
  128  shall be limited to $36,000 annually and may not exceed $200,000
  129  in total lifetime benefits.
  130         (c) Coverage may not be denied on the basis that provided
  131  services are habilitative in nature.
  132         (d) Coverage may be subject to other general exclusions and
  133  limitations of the insurer’s policy or plan, including, but not
  134  limited to, coordination of benefits, participating provider
  135  requirements, restrictions on services provided by family or
  136  household members, and utilization review of health care
  137  services, including the review of medical necessity, case
  138  management, and other managed care provisions.
  139         (5) The coverage required pursuant to subsection (3) may
  140  not be subject to dollar limits, deductibles, or coinsurance
  141  provisions that are less favorable to an insured than the dollar
  142  limits, deductibles, or coinsurance provisions that apply to
  143  physical illnesses that are generally covered under the health
  144  insurance plan, except as otherwise provided in subsection (4).
  145         (6) An insurer may not deny or refuse to issue coverage for
  146  medically necessary services, refuse to contract with, or refuse
  147  to renew or reissue or otherwise terminate or restrict coverage
  148  for an individual because the individual is diagnosed as having
  149  a developmental disability.
  150         (7) The treatment plan required pursuant to subsection (4)
  151  shall include all elements necessary for the health insurance
  152  plan to appropriately pay claims. These elements include, but
  153  are not limited to, a diagnosis, the proposed treatment by type,
  154  the frequency and duration of treatment, the anticipated
  155  outcomes stated as goals, the frequency with which the treatment
  156  plan will be updated, and the signature of the treating
  157  physician.
  158         (8) Beginning January 1, 2011, the maximum benefit under
  159  paragraph (4)(b) shall be adjusted annually on January 1 of each
  160  calendar year to reflect any change from the previous year in
  161  the medical component of the then current Consumer Price Index
  162  for all urban consumers, published by the Bureau of Labor
  163  Statistics of the United States Department of Labor.
  164         (9) This section may not be construed as limiting benefits
  165  and coverage otherwise available to an insured under a health
  166  insurance plan.
  167         (10) The Office of Insurance Regulation may not enforce
  168  this section against an insurer that becomes is a signatory no
  169  later than April 1, 2009, to the developmental disabilities
  170  compact established under s. 624.916 by July 1, 2010. The Office
  171  of Insurance Regulation shall enforce this section against an
  172  insurer that is a signatory to the compact established under s.
  173  624.916 if the insurer has not complied with the terms of the
  174  compact for all health insurance plans by April 1, 2010.
  175  However, any provisions of this section which are amended
  176  effective July 1, 2010, may not be enforced retroactively.
  177         Section 3. Subsections (2) and (3) of section 641.31098,
  178  Florida Statutes, are amended to read:
  179         641.31098 Coverage for individuals with developmental
  180  disabilities.—
  181         (2) As used in this section, the term:
  182         (a) “Applied behavior analysis” means the design,
  183  implementation, and evaluation of environmental modifications,
  184  using behavioral stimuli and consequences, to produce socially
  185  significant improvement in human behavior, including, but not
  186  limited to, the use of direct observation, measurement, and
  187  functional analysis of the relations between environment and
  188  behavior.
  189         (b) “Autism spectrum disorder” means any of the following
  190  disorders as defined in the most recent edition of the
  191  Diagnostic and Statistical Manual of Mental Disorders of the
  192  American Psychiatric Association:
  193         1. Autistic disorder.
  194         2. Asperger’s syndrome.
  195         3. Pervasive developmental disorder not otherwise
  196  specified.
  197         (c) “Developmental disability” means a disorder or syndrome
  198  attributable to cerebral palsy or Down syndrome, which manifests
  199  before the age of 18 years and constitutes a substantial
  200  handicap that can reasonably be expected to continue
  201  indefinitely. As used in this section:
  202         1. “Cerebral palsy” has the same meaning as in s. 393.063.
  203         2. “Down syndrome” means a disorder caused by the presence
  204  of an extra chromosome 21.
  205         (d)“Direct patient access” means the ability of an insured
  206  to obtain services from an in-network provider without a
  207  referral or other authorization before receiving services.
  208         (e)(c) “Eligible individual” means an individual under 18
  209  years of age or an individual 18 years of age or older who is in
  210  high school and who has been diagnosed as having a developmental
  211  disability at 8 years of age or younger.
  212         (f)(d) “Health maintenance contract” means a group health
  213  maintenance contract offered by a health maintenance
  214  organization. The This term does not include a health
  215  maintenance contract offered in the individual market, a health
  216  maintenance contract that is individually underwritten, or a
  217  health maintenance contract provided to a small employer.
  218         (3) A health maintenance contract must issued or renewed on
  219  or after April 1, 2009, shall provide coverage to an eligible
  220  individual for:
  221         (a) Direct patient access to one appropriate specialist, as
  222  defined in s. 381.986, for a minimum of three visits per policy
  223  year for the screening for, evaluation of, or diagnosis of
  224  autism spectrum disorder or other developmental disability.
  225         (b)(a) Well-baby and well-child screening for diagnosing
  226  the presence of autism spectrum disorder.
  227         (c)(b) Treatment of autism spectrum disorder or other
  228  developmental disability through speech therapy, occupational
  229  therapy, physical therapy, and applied behavior analysis
  230  services. Applied behavior analysis services shall be provided
  231  by an individual certified pursuant to s. 393.17 or an
  232  individual licensed under chapter 490 or chapter 491.
  233         Section 4. The Legislature finds that the provision of
  234  accessible and affordable quality health care permits all people
  235  to lead productive and meaningful lives, and, to this end, it
  236  further finds that this act fulfills an important state
  237  interest.
  238         Section 5. This act shall take effect July 1, 2010, and
  239  applies to policies issued or renewed on or after that date.

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