H.F. _____ Section 1. Section 225D.1, subsection 2, Code 2022, is 1 amended to read as follows: 2 2. “Autism” means autism spectrum disorders disorder as 3 defined in section 514C.28 . 4 Sec. 2. Section 321.189, subsection 10, Code 2022, is 5 amended to read as follows: 6 10. Autism spectrum disorder status. A licensee who has an 7 autism spectrum disorder, as defined in section 514C.28 , may 8 request that the license be marked to reflect the licensee’s 9 autism spectrum disorder status on the face of the license 10 when the licensee applies for the issuance or renewal of a 11 license. The department may adopt rules pursuant to chapter 12 17A establishing criteria under which a license may be marked, 13 including requiring the licensee to submit medical proof of the 14 licensee’s autism spectrum disorder status. When a driver’s 15 license is so marked, the licensee’s autism spectrum disorder 16 status shall be noted in the electronic database used by 17 the department and law enforcement to access registration, 18 titling, and driver’s license information. The department, in 19 consultation with the mental health and disability services 20 commission, shall develop educational media to raise awareness 21 of a licensee’s ability to request the license be marked to 22 reflect the licensee’s autism spectrum disorder status. 23 Sec. 3. Section 321.190, subsection 1, paragraph b, 24 subparagraph (6), Code 2022, is amended to read as follows: 25 (6) An applicant for a nonoperator’s identification card 26 who has an autism spectrum disorder, as defined in section 27 514C.28 , may request that the card be marked to reflect 28 the applicant’s autism spectrum disorder status on the face 29 of the card when the applicant applies for the issuance or 30 renewal of a card. The department may adopt rules pursuant to 31 chapter 17A establishing criteria under which a card may be 32 marked, including requiring the applicant to submit medical 33 proof of the applicant’s autism spectrum disorder status. 34 The department, in consultation with the mental health and 35 -1- LSB 5417YC (6) 89 ko/rh 1/ 6

H.F. _____ disability services commission, shall develop educational 1 media to raise awareness of an applicant’s ability to request 2 the card be marked to reflect the applicant’s autism spectrum 3 disorder status. 4 Sec. 4. Section 514C.28, subsection 1, Code 2022, is amended 5 to read as follows: 6 1. Notwithstanding the uniformity of treatment requirements 7 of section 514C.6 , a group plan established pursuant to chapter 8 509A for employees of the state providing for third-party 9 payment or prepayment of health, medical, and surgical coverage 10 benefits shall provide coverage benefits to covered individuals 11 under twenty-one years of age for the diagnostic assessment of 12 autism spectrum disorders disorder and for the treatment of 13 autism spectrum disorders disorder . 14 Sec. 5. Section 514C.28, subsection 2, paragraphs b, c, d, 15 j, and k, Code 2022, are amended to read as follows: 16 b. “Autism service provider” means a person, or group 17 providing treatment of autism spectrum disorders disorder . 18 An autism service provider that provides treatment of autism 19 spectrum disorders disorder that includes applied behavioral 20 analysis shall be certified as a behavior analyst by the 21 behavior analyst certification board or shall be a health 22 professional licensed under chapter 147 . 23 c. “Autism spectrum disorders disorder ” means any of the 24 pervasive developmental disorders including autistic disorder, 25 Asperger’s disorder, and pervasive developmental disorders 26 not otherwise specified. The commissioner, by rule, shall 27 define “autism spectrum disorders” consistent with definitions 28 provided in the most recent edition of the American psychiatric 29 association’s diagnostic and statistical manual of mental 30 disorders, as such definitions may be amended from time to 31 time. The commissioner may adopt the definitions provided in 32 such manual by reference a mental health condition that meets 33 the diagnostic criteria for such disorder as published in the 34 most recent edition of the diagnostic and statistical manual 35 -2- LSB 5417YC (6) 89 ko/rh 2/ 6

H.F. _____ of mental disorders as published by the American psychiatric 1 association . 2 d. “Diagnostic assessment of autism spectrum disorders 3 disorder ” means medically necessary assessment, evaluations, 4 or tests performed by a licensed physician, licensed physician 5 assistant, licensed psychologist, or licensed registered nurse 6 practitioner to diagnose whether an individual has an autism 7 spectrum disorder. 8 j. “Treatment of autism spectrum disorders disorder ” 9 means treatment that is identified in a treatment plan and 10 includes medically necessary pharmacy care, psychiatric care, 11 psychological care, rehabilitative care, and therapeutic care 12 that is one of the following: 13 (1) Prescribed, ordered, or provided by a licensed 14 physician, licensed physician assistant, licensed psychologist, 15 licensed social worker, or licensed registered nurse 16 practitioner. 17 (2) Provided by an autism service provider. 18 (3) Provided by a person, entity, or group that works under 19 the direction of an autism service provider. 20 k. “Treatment plan” means a plan for the treatment of autism 21 spectrum disorders disorder developed by a licensed physician 22 or licensed psychologist pursuant to a comprehensive evaluation 23 or reevaluation performed in consultation with the patient and 24 the patient’s representative. 25 Sec. 6. Section 514C.28, subsections 3, 7, and 10, Code 26 2022, are amended to read as follows: 27 3. Coverage is required pursuant to this section in a 28 maximum benefit amount of not more than thirty-six thousand 29 dollars per year but shall not be subject to any limits on the 30 number of visits to an autism service provider for treatment 31 of autism spectrum disorders disorder . Beginning in 2014, the 32 The commissioner shall, on or before April 1 of each calendar 33 year, publish an adjustment to the maximum benefit required 34 equal to the percentage change in the United States department 35 -3- LSB 5417YC (6) 89 ko/rh 3/ 6

H.F. _____ of labor consumer price index for all urban consumers in the 1 preceding year, and the published adjusted maximum benefit 2 shall be applicable to group policies, contracts, or plans 3 subject to this section that are issued or renewed on or after 4 January 1 of the following calendar year. Payments made under 5 a group plan subject to this section on behalf of a covered 6 individual for treatment of a health condition unrelated to or 7 distinguishable from the individual’s autism spectrum disorder 8 shall not be applied toward any maximum benefit established 9 under this subsection . 10 7. This section shall not be construed to require coverage 11 by a group plan of any service solely based on inclusion of the 12 service in an individualized education program. Consistent 13 with federal or state law and upon consent of the parent or 14 guardian of a covered individual, the treatment of autism 15 spectrum disorders disorder may be coordinated with any 16 services included in an individualized education program. 17 However, coverage for the treatment of autism spectrum 18 disorders disorder shall not be contingent upon coordination of 19 services with an individualized education program. 20 10. An insurer may review a treatment plan for treatment 21 of autism spectrum disorders disorder once every six months, 22 subject to its utilization review requirements, including 23 case management, concurrent review, and other managed care 24 provisions. A more or less frequent review may be agreed 25 upon by the insured and the licensed physician or licensed 26 psychologist developing the treatment plan. 27 Sec. 7. Section 514C.31, subsection 2, paragraphs b and d, 28 Code 2022, are amended to read as follows: 29 b. “Autism spectrum disorder” means a complex 30 neurodevelopmental medical disorder characterized by social 31 impairment, communication difficulties, and restricted, 32 repetitive, and stereotyped patterns of behavior the same as 33 defined in section 514C.28, subsection 2 . 34 d. “Treatment plan” means a plan for the treatment of an 35 -4- LSB 5417YC (6) 89 ko/rh 4/ 6

H.F. _____ autism spectrum disorder developed by a licensed physician 1 or licensed psychologist after a comprehensive evaluation or 2 reevaluation performed in a manner consistent with the most 3 recent clinical report or recommendations of the American 4 academy of pediatrics. “Treatment plan” includes supervisory 5 services, subject to the provisions of subsection 5 . 6 Sec. 8. APPLICABILITY. 7 1. The sections of this Act amending section 514C.28 apply 8 to plans established pursuant to chapter 509A for employees of 9 the state that are delivered, issued for delivery, continued, 10 or renewed in this state on or after January 1, 2023. 11 2. The section of this Act amending section 514C.31 12 applies to third-party provider payment contracts, policies, 13 or plans specified in section 514C.31, subsection 1, paragraph 14 “a”, or to plans established pursuant to chapter 509A for 15 public employees other than employees of the state, that are 16 delivered, issued for delivery, continued, or renewed in this 17 state on or after January 1, 2023. 18 EXPLANATION 19 The inclusion of this explanation does not constitute agreement with 20 the explanation’s substance by the members of the general assembly. 21 This bill is related to the definition of autism spectrum 22 disorder for purposes of certain health care coverage. 23 Under current law, “autism spectrum disorders” is defined as 24 any of the pervasive developmental disorders including autistic 25 disorder, Asperger’s disorder, and pervasive developmental 26 disorders not otherwise specified. The commissioner of 27 insurance, by rule, is required to define “autism spectrum 28 disorders” consistent with definitions provided in the most 29 recent edition of the American psychiatric association’s 30 diagnostic and statistical manual of mental disorders, and may 31 adopt the definitions provided in the manual by reference. 32 Under the bill, “autism spectrum disorder” is defined as a 33 mental health condition that meets the diagnostic criteria 34 for such disorder as published in the most recent edition of 35 -5- LSB 5417YC (6) 89 ko/rh 5/ 6

H.F. _____ the diagnostic and statistical manual of mental disorders, as 1 published by the American psychiatric association. 2 The sections of the bill that amend Code section 514C.28 3 apply to plans established pursuant to Code chapter 509A for 4 employees of the state that are delivered, issued for delivery, 5 continued, or renewed in this state on or after January 1, 6 2023. The section of the bill that amends Code section 514C.31 7 applies to third-party provider payment contracts, policies, 8 or plans specified in Code section 514C.31(1)(a), or to plans 9 established pursuant to Code chapter 509A for public employees 10 other than employees of the state, that are delivered, issued 11 for delivery, continued, or renewed in this state on or after 12 January 1, 2023. 13 The bill makes conforming changes to Code chapter 225D 14 (autism support program), Code section 321.189 (driver’s 15 license —— content), and Code section 321.190 (issuance of 16 nonoperator’s identification cards —— fee). 17 -6- LSB 5417YC (6) 89 ko/rh 6/ 6