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
(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
(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
(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
(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
(g) "Psychological care" means direct or consultative services
provided by a psychologist licensed in the state in which the
(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.