H.F. 330 Section 1. Section 514C.22, subsection 3, paragraph g, Code 1 2025, is amended to read as follows: 2 g. Autistic disorders Autism spectrum disorder . 3 Sec. 2. Section 514C.22, subsection 4, Code 2025, is amended 4 to read as follows: 5 4. The commissioner, by rule, shall define definitions 6 of the biologically based mental illnesses identified in 7 subsection 3 . Definitions established by the commissioner 8 shall be consistent with definitions provided in the most 9 recent edition of the American psychiatric association’s 10 diagnostic and statistical manual of mental disorders, as such 11 definitions may be amended from time to time. The commissioner 12 may adopt the definitions provided in such manual by reference. 13 Sec. 3. Section 514C.22, subsection 7, Code 2025, is amended 14 by adding the following new paragraph: 15 NEW PARAGRAPH . c. Notwithstanding paragraphs “a” and “b” , 16 a group policy, contract, or plan covered under this section 17 shall not impose an aggregate annual or lifetime limit on 18 biologically based mental illness coverage benefits for autism 19 spectrum disorder. 20 Sec. 4. Section 514C.22, subsection 8, unnumbered paragraph 21 1, Code 2025, is amended to read as follows: 22 A group policy, contract, or plan covered under this 23 section shall at a minimum allow for thirty inpatient days 24 and fifty-two outpatient visits annually , and shall not 25 limit the number of outpatient visits a covered individual 26 may have with a practitioner for applied behavior analysis 27 under section 514C.31, or with an autism service provider for 28 treatment of autism spectrum disorder under section 514C.28 . 29 The policy, contract, or plan may also include deductibles, 30 coinsurance, or copayments, provided the amounts and extent 31 of such deductibles, coinsurance, or copayments applicable to 32 other health, medical, or surgical services coverage under the 33 policy, contract, or plan are the same. It is not a violation 34 of this section if the policy, contract, or plan excludes 35 -1- LSB 1335HV (2) 91 nls/ko 1/ 5

H.F. 330 entirely from coverage benefits for the cost of providing the 1 following: 2 Sec. 5. Section 514C.28, subsections 1, 3, and 5, Code 2025, 3 are amended to read as follows: 4 1. Notwithstanding the uniformity of treatment requirements 5 of section 514C.6 , a group plan established pursuant to chapter 6 509A for employees of the state providing for third-party 7 payment or prepayment of health, medical, and surgical coverage 8 benefits shall provide coverage benefits to covered individuals 9 under twenty-one years of age for the diagnostic assessment 10 of autism spectrum disorder and for the treatment of autism 11 spectrum disorder. 12 3. Coverage is required pursuant to this section in a 13 maximum benefit amount of not more than thirty-six thousand 14 dollars per year but shall not be subject to any limits on 15 the number of visits to a covered individual may have with 16 an autism service provider for treatment of autism spectrum 17 disorder. The commissioner shall, on or before April 1 of 18 each calendar year, publish an adjustment to the maximum 19 benefit required equal to the percentage change in the United 20 States department of labor consumer price index for all urban 21 consumers in the preceding year, and the published adjusted 22 maximum benefit shall be applicable to group policies, 23 contracts, or plans subject to this section that are issued 24 or renewed on or after January 1 of the following calendar 25 year. Payments made under a group plan subject to this section 26 on behalf of a covered individual for treatment of a health 27 condition unrelated to or distinguishable from the individual’s 28 autism spectrum disorder shall not be applied toward any 29 maximum benefit established under this subsection . 30 5. Coverage required by this section shall be provided 31 in coordination with coverage required for the treatment of 32 autistic disorders autism spectrum disorder pursuant to section 33 514C.22 . 34 Sec. 6. Section 514C.28, subsection 2, paragraph c, Code 35 -2- LSB 1335HV (2) 91 nls/ko 2/ 5

H.F. 330 2025, is amended to read as follows: 1 c. “Autism spectrum disorder” means a mental health 2 condition that meets the diagnostic criteria for such disorder 3 as published in the most recent edition of the diagnostic and 4 statistical manual of mental disorders as published by the 5 American psychiatric association the same as defined in section 6 514C.22, subsection 4 . 7 Sec. 7. Section 514C.31, subsection 1, unnumbered paragraph 8 1, Code 2025, is amended to read as follows: 9 Notwithstanding the uniformity of treatment requirements of 10 section 514C.6 , a group policy, contract, or plan providing 11 for third-party payment or prepayment of health, medical, and 12 surgical coverage benefits shall provide coverage benefits for 13 applied behavior analysis provided by a practitioner to covered 14 individuals under nineteen years of age for the treatment of 15 autism spectrum disorder pursuant to a treatment plan if the 16 policy, contract, or plan is either of the following: 17 Sec. 8. Section 514C.31, subsection 3, Code 2025, is amended 18 by striking the subsection. 19 Sec. 9. Section 514C.31, subsections 4 and 5, Code 2025, are 20 amended to read as follows: 21 4. Coverage required pursuant to this section may be 22 subject to dollar limits, deductibles, copayments, or 23 coinsurance provisions that apply to other medical and surgical 24 services under the policy, contract, or plan , subject to the 25 requirements of subsection 3 . 26 5. Coverage required pursuant to this section may be 27 subject to care management provisions of the applicable 28 policy, contract, or plan, including prior authorization , and 29 prior approval , and limits on the number of visits a covered 30 individual may make for applied behavior analysis . 31 Sec. 10. APPLICABILITY. 32 1. The sections of this Act amending section 514C.22 apply 33 to third-party payment provider policies, contracts, and plans 34 as specified in section 514C.22 that are delivered, issued 35 -3- LSB 1335HV (2) 91 nls/ko 3/ 5

H.F. 330 for delivery, continued, or renewed in this state on or after 1 January 1, 2026. 2 2. The sections of this Act amending section 514C.28 apply 3 to a group plan established pursuant to 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 2026. 7 3. The sections of this Act amending section 514C.31 8 apply to third-party provider payment contracts, policies, or 9 plans specified in section 514C.31, subsection 1, paragraph 10 “a”, or to plans established pursuant to chapter 509A for 11 public employees other than employees of the state, that are 12 delivered, issued for delivery, continued, or renewed in this 13 state on or after January 1, 2026. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to insurance coverage for covered 18 individuals for the treatment of autism spectrum disorder 19 (autism). The bill changes the definition of autism 20 under current law to align with the American psychiatric 21 association’s diagnostic and statistical manual of mental 22 disorders. 23 Under current law, a group plan established pursuant to 24 Code chapter 509A for employees of the state that provides 25 for third-party payment or prepayment of health, medical, and 26 surgical coverage benefits (coverage) shall provide coverage to 27 covered individuals under 21 years of age for the diagnostic 28 assessment and treatment of autism, and coverage is required 29 in a maximum benefit amount of not more than $36,000 per year. 30 The bill eliminates the 21-year maximum age limit and the 31 maximum benefit amount. 32 Under current law, a group policy, contract, or plan 33 (policy) providing for third-party payment or prepayment 34 of health, medical, and surgical coverage shall provide 35 -4- LSB 1335HV (2) 91 nls/ko 4/ 5

H.F. 330 coverage for applied behavior analysis (analysis) provided 1 by a practitioner to covered individuals under 19 years of 2 age for the treatment of autism pursuant to a treatment plan 3 if the policy is either a policy issued by a carrier to an 4 employer who on at least 50 percent of the employer’s working 5 days during the preceding calendar year employed more than 50 6 full-time equivalent employees, or the policy is established 7 pursuant to Code chapter 509A for public employees other than 8 employees of the state. Under the bill, the age restriction 9 is eliminated. Current law requires that the coverage for 10 analysis shall provide an annual maximum benefit of not less 11 than $36,000 for individuals through age six, $25,000 for 12 individuals age 7 through 13, and $12,500 for individuals age 13 14 through 18. The bill eliminates the maximum benefit amounts 14 and the age categories. 15 The bill makes conforming changes to Code sections 514C.22 16 and 514C.28. 17 The bill applies to plans specified in the bill that are 18 delivered, issued for delivery, continued, or renewed in this 19 state on or after January 1, 2026. 20 -5- LSB 1335HV (2) 91 nls/ko 5/ 5