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COMMITTEE REPORT
March 15, 2007
S. 20
Introduced by Senators Elliott, Mescher, Cleary, Hutto, Lourie, Moore, Sheheen, Reese, Knotts, Leventis, Land, McGill, Rankin, Campsen, Grooms, Hawkins, Short and Scott
S. Printed 3/15/07--S. [SEC 3/19/07 10:59 AM]
Read the first time January 9, 2007.
To whom was referred a Bill (S. 20) to amend the Code of Laws of South Carolina, 1976, by adding Section 38-71-280 so as to require insurance coverage for treatment of pervasive developmental disorders, etc., respectfully
That they have duly and carefully considered the same and recommend that the same do pass with amendment:
Amend the bill, as and if amended, by inserting after the title and before the enacting words:
/Whereas, early intervention is the key to improving the health and well-being of children with autistic disorder, so that they may become active, contributing members of society; and
Whereas, children with autistic disorder can be diagnosed in early childhood and treatment should begin immediately upon diagnosis; and
Whereas, children with autistic disorder can benefit significantly from early, intensive speech therapy, physical therapy, occupational therapy, and behavioral therapy, which help to improve communication skills and functioning in everyday life activities; and
Whereas, children with autistic disorder have a neurological disorder, and many insurance policies provide benefits for treatment of neurological disorders. Now, therefore,/
Amend the bill, further, by striking all after the enacting words and inserting:
/SECTION 1. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-280. (A) As used in this chapter, 'autistic disorder' means a neurological condition that is marked by severe impairment in social interaction, communication, and imaginative play, with onset during the first three years of life.
(B) A group accident and health insurance policy, individual health maintenance organization contract, or group health maintenance organization contract must provide coverage for the treatment of autistic disorder. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew or refuse to reissue or otherwise terminate or restrict coverage on an individual under an insurance policy solely because the individual is diagnosed with autistic disorder.
(C) An insurer that issues an accident and health insurance policy on an individual basis must offer to provide coverage for the treatment of autistic disorder. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew or refuse to reissue or otherwise terminate or restrict coverage on an individual under an insurance policy solely because the individual is diagnosed with autistic disorder.
(D) The coverage required pursuant to subsection (B) or offered pursuant to subsection (C) must not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the accident and health insurance policy or the health maintenance organization contract. Coverage of services may be subject to other general exclusions and limitations of the contract or benefit plan, including, but not limited to, coordination of benefits, participating provider requirements, services provided by family or household member restrictions, eligibility, and appeals processes.
(E) The treatment plan required pursuant subsections (B) and (C) must include all elements necessary for the insurer or health maintenance organization to appropriately pay claims. These elements include, but are not limited to, a diagnosis, proposed treatment by type, frequency, and duration of treatment, the anticipated outcomes stated as goals, the frequency by which the treatment plan will be updated, and the treating physician's signature. The insurer may only request an updated treatment plan once every six months from the treating physician to review medical necessity, unless the insurer or health maintenance organization and the provider agree that a more frequent review is necessary due to emerging clinical circumstances.
(F) To be eligible for benefits and coverage under this section, an individual must be diagnosed with autistic disorder before reaching his or her eighth birthday. The benefits and coverage provided pursuant to this section must be provided to any eligible person under sixteen years of age. Coverage for behavioral therapy is subject to a seventy-five thousand dollar maximum benefit per year. The maximum period of coverage for behavioral therapy is three years, unless clinical progress reports demonstrate that the child is in a period of steady skill acquisition. For behavioral therapy to continue beyond three years, the child's physician must submit progress reports every six months demonstrating continuing, clinically-significant progress.
(G) Nothing in the section applies to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited benefit hospital insurance policies."
SECTION 2. This act takes effect upon approval by the Governor and applies to all accident and health insurance policies and health maintenance organization contracts issued, renewed, delivered, or entered into on or after this act's effective date or July 1, 2007, whichever occurs later./
Renumber sections to conform.
Amend title to conform.
DAVID L. THOMAS for Committee.
EXPLANATION OF IMPACT:
Budget and Control Board
The board indicates that this bill would have no impact on the General Fund of the State or federal and/or other funds as the State Health Plan is not covered by Title 38.
Department of Insurance
The department indicates that this bill would require one-time additional expenses totaling $30,000 for temporary or contract help to review all applicable policy forms for a year.
Approved By:
Don Addy
Office of State Budget
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-280 SO AS TO REQUIRE INSURANCE COVERAGE FOR TREATMENT OF PERVASIVE DEVELOPMENTAL DISORDERS AND TO DEFINE "PERVASIVE DEVELOPMENTAL DISORDER" AS A NEUROLOGICAL CONDITION, INCLUDING AUTISM AND ASPERGER'S SYNDROME.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-280. (A) As used in this section, 'pervasive developmental disorder' means a neurological condition, including autism and Asperger's syndrome, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
(B) An individual accident and health insurance policy, group accident and health insurance policy, individual health maintenance organization contract, or group health maintenance organization contract must provide coverage for the treatment of a pervasive developmental disorder of an insured. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage on an individual under an insurance policy solely because the individual is diagnosed with a pervasive developmental disorder.
(C) The coverage required under subsection (B) must not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the accident and health insurance policy or the health maintenance organization contract."
SECTION 2. This act takes effect July 1, 2007, and applies to all accident and health insurance policies and health maintenance organization contracts issued, renewed, delivered, or entered into after June 30, 2007.
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