Senate
File
2349
-
Reprinted
SENATE
FILE
2349
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
SF
1)
(As
Amended
and
Passed
by
the
Senate
February
23,
2010
)
A
BILL
FOR
An
Act
requiring
certain
group
health
insurance
plans
1
established
for
employees
of
the
state
to
provide
coverage
2
for
autism
spectrum
disorders
for
certain
persons,
requiring
3
certification
of
behavior
specialists,
and
providing
an
4
applicability
date.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
6
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Section
1.
NEW
SECTION
.
514C.26
Autism
spectrum
disorders
1
coverage.
2
1.
Notwithstanding
the
uniformity
of
treatment
requirements
3
of
section
514C.6,
a
group
plan
established
pursuant
to
chapter
4
509A
for
employees
of
the
state
providing
for
third-party
5
payment
or
prepayment
of
health,
medical,
and
surgical
coverage
6
benefits
shall
provide
coverage
benefits
to
covered
individuals
7
under
twenty-one
years
of
age
for
the
diagnostic
assessment
8
of
autism
spectrum
disorders
and
for
the
treatment
of
autism
9
spectrum
disorders.
10
2.
As
used
in
this
section,
unless
the
context
otherwise
11
requires:
12
a.
“Applied
behavioral
analysis”
means
the
design,
13
implementation,
and
evaluation
of
environmental
modifications,
14
using
behavioral
stimuli
and
consequences,
to
produce
socially
15
significant
improvement
in
human
behavior
or
to
prevent
loss
16
of
attained
skill
or
function,
including
the
use
of
direct
17
observation,
measurement,
and
functional
analysis
of
the
18
relations
between
environment
and
behavior.
19
b.
“Autism
service
provider”
means
a
person,
entity,
20
or
group
providing
treatment
of
autism
spectrum
disorders,
21
pursuant
to
a
treatment
plan.
22
c.
“Autism
spectrum
disorders”
means
any
of
the
pervasive
23
developmental
disorders
including
autistic
disorder,
Asperger’s
24
disorder,
and
pervasive
developmental
disorders
not
otherwise
25
specified.
The
commissioner,
by
rule,
shall
define
“autism
26
spectrum
disorders”
consistent
with
definitions
provided
in
the
27
most
recent
edition
of
the
American
psychiatric
association’s
28
diagnostic
and
statistical
manual
of
mental
disorders,
as
such
29
definitions
may
be
amended
from
time
to
time.
The
commissioner
30
may
adopt
the
definitions
provided
in
such
manual
by
reference.
31
d.
“Behavior
specialist”
means
an
individual,
certified
by
32
the
board
of
medicine,
who
designs,
implements,
or
evaluates
33
a
behavior
modification
intervention
component
of
a
treatment
34
plan,
including
those
based
on
applied
behavioral
analysis,
to
35
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produce
socially
significant
improvements
in
human
behavior
or
1
to
prevent
loss
of
attained
skill
or
function,
through
skill
2
acquisition
and
the
reduction
of
problematic
behavior.
3
e.
“Diagnostic
assessment
of
autism
spectrum
disorders”
means
4
medically
necessary
assessment,
evaluations,
or
tests
performed
5
by
a
licensed
physician,
licensed
physician
assistant,
licensed
6
psychologist,
or
licensed
registered
nurse
practitioner
to
7
diagnose
whether
an
individual
has
an
autism
spectrum
disorder.
8
f.
“Pharmacy
care”
means
medications
prescribed
by
a
9
licensed
physician,
licensed
physician
assistant,
or
licensed
10
registered
nurse
practitioner
and
any
assessment,
evaluation,
11
or
test
prescribed
or
ordered
by
a
licensed
physician,
licensed
12
physician
assistant,
or
licensed
registered
nurse
practitioner
13
to
determine
the
need
for
or
effectiveness
of
such
medications.
14
g.
“Psychiatric
care”
means
direct
or
consultative
services
15
provided
by
a
licensed
physician
who
specializes
in
psychiatry.
16
h.
“Psychological
care”
means
direct
or
consultative
17
services
provided
by
a
licensed
psychologist.
18
i.
“Rehabilitative
care”
means
professional
services
and
19
treatment
programs,
including
applied
behavioral
analysis,
20
provided
by
an
autism
service
provider
to
produce
socially
21
significant
improvement
in
human
behavior
or
to
prevent
loss
22
of
attained
skill
or
function.
23
j.
“Therapeutic
care”
means
services
provided
by
a
licensed
24
speech
pathologist,
licensed
occupational
therapist,
or
25
licensed
physical
therapist.
26
k.
“Treatment
of
autism
spectrum
disorders”
means
treatment
27
that
is
identified
in
a
treatment
plan
and
includes
medically
28
necessary
pharmacy
care,
psychiatric
care,
psychological
care,
29
rehabilitative
care,
and
therapeutic
care
that
is
one
of
the
30
following:
31
(1)
Prescribed,
ordered,
or
provided
by
a
licensed
32
physician,
licensed
physician
assistant,
licensed
psychologist,
33
licensed
social
worker,
or
licensed
registered
nurse
34
practitioner.
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(2)
Provided
by
an
autism
service
provider.
1
(3)
Provided
by
a
person,
entity,
or
group
that
works
under
2
the
direction
of
an
autism
service
provider.
3
l.
“Treatment
plan”
means
a
plan
for
the
treatment
of
4
autism
spectrum
disorders
developed
by
a
licensed
physician
or
5
licensed
psychologist
pursuant
to
a
comprehensive
evaluation
6
or
reevaluation
performed
in
a
manner
consistent
with
the
most
7
recent
clinical
report
or
recommendations
of
the
American
8
academy
of
pediatrics,
as
determined
by
the
commissioner
by
9
rule.
10
3.
Coverage
is
required
pursuant
to
this
section
in
a
11
maximum
benefit
amount
of
not
more
than
thirty-six
thousand
12
dollars
per
year
but
shall
not
be
subject
to
any
limits
13
on
the
number
of
visits
to
an
autism
service
provider
for
14
treatment
of
autism
spectrum
disorders.
Beginning
in
2014,
15
the
commissioner
shall,
on
or
before
April
1
of
each
calendar
16
year,
publish
an
adjustment
to
the
maximum
benefit
required
17
equal
to
the
percentage
change
in
the
United
States
department
18
of
labor
consumer
price
index
for
all
urban
consumers
in
the
19
preceding
year,
and
the
published
adjusted
maximum
benefit
20
shall
be
applicable
to
group
policies,
contracts,
or
plans
21
subject
to
this
section
that
are
issued
or
renewed
on
or
after
22
January
1
of
the
following
calendar
year.
Payments
made
under
23
a
group
plan
subject
to
this
section
on
behalf
of
a
covered
24
individual
for
treatment
of
a
health
condition
unrelated
to
or
25
distinguishable
from
the
individual’s
autism
spectrum
disorder
26
shall
not
be
applied
toward
any
maximum
benefit
established
27
under
this
subsection.
28
4.
Coverage
required
pursuant
to
this
section
shall
be
29
subject
to
copayment,
deductible,
and
coinsurance
provisions,
30
and
any
other
general
exclusions
or
limitations
of
a
group
31
plan
to
the
same
extent
as
other
medical
or
surgical
services
32
covered
by
the
group
plan.
33
5.
Coverage
required
by
this
section
shall
be
provided
34
in
coordination
with
coverage
required
for
the
treatment
of
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autistic
disorders
pursuant
to
section
514C.22.
1
6.
This
section
shall
not
be
construed
to
limit
benefits
2
which
are
otherwise
available
to
an
individual
under
a
group
3
plan.
4
7.
This
section
shall
not
be
construed
to
require
coverage
5
by
a
group
plan
of
any
service
solely
based
on
inclusion
of
the
6
service
in
an
individualized
education
program.
Consistent
7
with
federal
or
state
law
and
upon
consent
of
the
parent
or
8
guardian
of
a
covered
individual,
the
treatment
of
autism
9
spectrum
disorders
may
be
coordinated
with
any
services
10
included
in
an
individualized
education
program.
However,
11
coverage
for
the
treatment
of
autism
spectrum
disorders
12
shall
not
be
contingent
upon
coordination
of
services
with
an
13
individualized
education
program.
14
8.
This
section
shall
not
apply
to
accident-only,
15
specified
disease,
short-term
hospital
or
medical,
hospital
16
confinement
indemnity,
credit,
dental,
vision,
Medicare
17
supplement,
long-term
care,
basic
hospital
and
medical-surgical
18
expense
coverage
as
defined
by
the
commissioner,
disability
19
income
insurance
coverage,
coverage
issued
as
a
supplement
20
to
liability
insurance,
workers’
compensation
or
similar
21
insurance,
or
automobile
medical
payment
insurance,
or
22
individual
accident
and
sickness
policies
issued
to
individuals
23
or
to
individual
members
of
a
member
association.
24
9.
A
plan
established
pursuant
to
chapter
509A
for
employees
25
of
the
state
may
manage
the
benefits
provided
through
common
26
methods
including
but
not
limited
to
providing
payment
of
27
benefits
or
providing
care
and
treatment
under
a
capitated
28
payment
system,
prospective
reimbursement
rate
system,
29
utilization
control
system,
incentive
system
for
the
use
of
30
least
restrictive
and
costly
levels
of
care,
a
preferred
31
provider
contract
limiting
choice
of
specific
providers,
or
32
any
other
system,
method,
or
organization
designed
to
assure
33
services
are
medically
necessary
and
clinically
appropriate.
34
10.
An
insurer
may
review
a
treatment
plan
for
treatment
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of
autism
spectrum
disorders
once
every
six
months,
subject
to
1
its
utilization
review
requirements,
including
case
management,
2
concurrent
review,
and
other
managed
care
provisions.
A
more
3
or
less
frequent
review
may
be
agreed
upon
by
the
insured
and
4
the
licensed
physician
or
licensed
psychologist
developing
the
5
treatment
plan.
6
11.
For
the
purposes
of
this
section,
the
results
of
a
7
diagnostic
assessment
of
autism
spectrum
disorder
shall
be
8
valid
for
a
period
of
not
less
than
twelve
months,
unless
a
9
licensed
physician
or
licensed
psychologist
determines
that
a
10
more
frequent
assessment
is
necessary.
11
12.
The
board
of
medicine
shall
adopt
rules
providing
for
12
the
certification
of
behavior
specialists.
13
a.
An
applicant
for
a
certificate
as
a
behavior
specialist
14
shall
submit
a
written
application
on
forms
provided
by
the
15
board
of
medicine
evidencing
and
insuring
that
the
applicant
16
meets
all
of
the
following
requirements:
17
(1)
Is
of
good
moral
character.
18
(2)
Has
received
a
master’s
or
higher
degree
from
a
19
board-approved,
accredited
college
or
university,
including
20
a
major
course
of
study
in
school,
clinical,
or
counseling
21
psychology,
special
education,
social
work,
speech
therapy,
22
occupational
therapy,
or
another
related
field.
23
(3)
Has
at
least
one
year
of
experience
involving
24
functional
behavior
assessments,
including
the
development
and
25
implementation
of
behavioral
supports
or
treatment
plans.
26
(4)
Has
completed
at
least
one
thousand
hours
in
direct
27
clinical
experience
with
individuals
with
behavioral
challenges
28
or
at
least
one
thousand
hours
experience
in
a
related
field
29
with
individuals
with
autism
spectrum
disorders.
30
(5)
Has
completed
relevant
training
programs,
including
31
professional
ethics,
autism-specific
training,
assessments
32
training,
instructional
strategies
and
best
practices,
33
crisis
intervention,
comorbidity
and
medications,
family
34
collaboration,
and
addressing
specific
skill
deficits
training.
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b.
The
board
of
medicine
shall
not
issue
a
certificate
to
an
1
applicant
who
has
been
convicted
of
a
felony,
of
a
controlled
2
substance-related
offense
under
chapter
124
or
of
the
laws
of
3
another
jurisdiction
unless
all
of
the
following
requirements
4
have
been
met:
5
(1)
At
least
ten
years
have
elapsed
from
the
date
of
6
conviction
of
such
an
offense.
7
(2)
The
applicant
satisfactorily
demonstrates
to
the
board
8
of
medicine
that
the
applicant
has
made
significant
progress
9
in
personal
rehabilitation
since
the
conviction
such
that
10
certification
of
the
applicant
would
not
be
expected
to
create
11
a
substantial
risk
of
harm
to
the
health
and
safety
of
patients
12
or
the
public,
or
a
substantial
risk
of
further
criminal
13
violations.
14
(3)
The
applicant
otherwise
satisfies
the
requirements
of
15
this
subsection.
16
13.
The
commissioner
shall
adopt
rules
pursuant
to
chapter
17
17A
to
implement
and
administer
this
section.
18
14.
This
section
applies
to
plans
established
pursuant
to
19
chapter
509A
for
employees
of
the
state
that
are
delivered,
20
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
21
after
January
1,
2011.
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