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.




     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




     (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


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.