SENATE BILL No. 414

 

 

June 8, 2011, Introduced by Senators GREEN, CASWELL, RICHARDVILLE, EMMONS, GLEASON, SMITH, WHITMER, BIEDA, YOUNG, HOOD, GREGORY, JOHNSON, PAPPAGEORGE, BOOHER and WARREN and referred to the Committee on Health Policy.

 

 

 

     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 diagnosis and treatment

 

of autism spectrum disorders.

 

     (2) Coverage under this section is not subject to limits on

 

the number of visits a member may use for treatment of autism

 

spectrum disorders.

 

     (3) Coverage under this section shall not be denied or limited

 

on the basis that it is educational or habilitative in nature.

 

     (4) Except as provided in subsection (5), coverage under this

 

section shall not be subject to dollar limits, copays, deductibles,

 

or coinsurance provisions that do not apply to physical illness

 


generally.

 

     (5) Coverage under this section for applied behavior analysis

 

may be subject to a maximum annual benefit of $50,000.00 and may be

 

limited to a member up to age 18.

 

     (6) This section shall not be construed as limiting benefits

 

that are otherwise available to a member under a certificate.

 

     (7) If a member is receiving treatment for autism spectrum

 

disorder, a health care corporation may request a review of that

 

treatment consistent with current protocols and may require a

 

treatment plan. The cost of obtaining a treatment review shall be

 

borne by the health care corporation. A health care corporation

 

shall utilize evidence-based care and managed care cost-containment

 

practices in accordance with the health care corporation's

 

procedures so long as that care and those practices are consistent

 

with this section.

 

     (8) As used in this section:

 

     (a) "Applied behavior analysis" means the design,

 

implementation, and evaluation of environmental modifications,

 

using behavioral stimuli and consequences, to produce significant

 

improvement in human behavior, including the use of direct

 

observation, measurement, and functional analysis of the

 

relationship between environment and behavior.

 

     (b) "Autism spectrum disorders" means any of the following

 

pervasive developmental disorders as defined by the "Diagnostic and

 

Statistical Manual of Mental Disorders" of the American psychiatric

 

association:

 

     (i) Autistic disorder.

 


     (ii) Asperger's disorder.

 

     (iii) Pervasive developmental disorder not otherwise specified.

 

     (c) "Behavior health treatment" means professional,

 

counseling, and guidance services and treatment programs, including

 

applied behavior analysis if provided or supervised by a certified

 

behavior analyst, that are necessary to develop, maintain, and

 

restore, to the maximum extent practicable, the functioning of an

 

individual.

 

     (d) "Diagnosis of autism spectrum disorders" means

 

assessments, evaluations, or tests performed by a licensed

 

physician or a licensed psychologist to diagnose whether an

 

individual has 1 of the autism spectrum disorders.

 

     (e) "Pharmacy care" means medications prescribed by a licensed

 

physician and related services performed by a licensed pharmacist

 

and any health-related services considered medically necessary to

 

determine the need or effectiveness of the medications.

 

     (f) "Psychiatric care" means direct or consultative services

 

provided by a psychiatrist licensed in the state in which the

 

psychiatrist practices.

 

     (g) "Psychological care" means direct or consultative services

 

provided by a psychologist licensed in the state in which the

 

psychologist practices.

 

     (h) "Therapeutic care" means services provided by a licensed

 

or certified speech therapist, occupational therapist, physical

 

therapist, or social worker.

 

     (i) "Treatment of autism spectrum disorders" means evidence-

 

based treatment that includes the following care prescribed or

 


ordered for an individual diagnosed with 1 of the autism spectrum

 

disorders by a licensed physician or a licensed psychologist who

 

determines the care to be medically necessary:

 

     (i) Behavioral health treatment.

 

     (ii) Pharmacy care.

 

     (iii) Psychiatric care.

 

     (iv) Psychological care.

 

     (v) Therapeutic care.

 

     (j) "Treatment plan" means a written comprehensive evaluation

 

by a multidisciplinary team, individualized for each patient, and

 

developed by a licensed physician or licensed psychologist.

 

     Enacting section 1. This amendatory act applies to

 

certificates delivered, executed, issued, amended, adjusted, or

 

renewed in this state beginning 180 days after the date this

 

amendatory act is enacted into law.