bill mandating insurance coverage for autism spectrum disorders
A bill to amend 1980 PA 350, entitled
nonprofit health care corporation reform act,"
to 550.1704) by adding section 416e.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
A health care corporation group or nongroup certificate
shall provide coverage for the screening, diagnosis, and the
treatment of autism spectrum disorder, including, but not limited
to, coverage for speech therapy, occupational therapy, physical
therapy, psychological services, psychiatric services, and
applied behavior analysis, as prescribed or ordered by the
insured’s treating physician or psychologist. no
health care corporation may deny coverage or refuse to reissue
coverage for an individual solely because that individual is
diagnosed with autism spectrum disorder.
Coverage for autism spectrum disorder under this section is
subject to the same terms and conditions that the health
care corporation applies to the treatment of other disorders,
except as follows:
may not be limited or denied on the basis that it is habilitative
(B) treatment for autism spectrum disorder may not
be subject to visit limits, but shall be subject to a maximum
benefit of no less than $50,000 per year. After December
31, 2008, this maximum benefit will be adjusted for inflation
by using the medical care component of the United states department
of labor consumer price index for all urban consumers.
an insured is receiving treatment for autism spectrum disorder,
a health care corporation may request a review of that treatment
not more than once every six months unless the health care
corporation and the insured’s
treating physician or psychologist agree that a more frequent
review is necessary. The cost of obtaining any review shall
be borne by the health care corporation.
section shall not be construed as limiting benefits that are
otherwise available to an insured with an autism spectrum disorder.
As used in this section, "autism
spectrum disorder" means any of the pervasive developmental
disorders as defined by the most recent edition of the Diagnostic
and statistical manual of mental disorders (DSM), including autistic
disorder, asperger’s disorder, and pervasive developmental
disorder not otherwise specified.
used in this section, “Applied
behavior analysis” means the design, implementation, and
evaluation of environmental modifications, using behavioral stimuli
and consequences, to produce socially significant improvement
in human behavior, including the use of direct observation, measurement,
and functional analysis of the relations between environment