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BAAM Practice Watch |
Draft bill mandating insurance coverage for autism spectrum disorders in Michigan
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
| (MCL 550.1101 to 550.1704) by adding section 416e.THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 416e.
(1) 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.
(2) 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:
(A) treatment may not be limited or denied on the basis that it is habilitative in nature;
(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.
(3) if 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.
(4) This section shall not be construed as limiting benefits that are otherwise available to an insured with an autism spectrum disorder.
(5) 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.
(6) As 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 and behavior.