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Introduced Version House Bill 2699 History

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H. B. 2699

 

         (By Delegates Rodighiero, D. Campbell and Hunt)

         [Introduced January 21, 2011; referred to the

         Committee on Banking and Insurance then Finance.]

 

 

 

 

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-7f; that said code be amended by adding thereto a new section, designated §5-16B-6e; that said code be amended by adding thereto a new section, designated §33-15-22; that said code be amended by adding thereto a new section, designated §33-16-18; and that said code be amended by adding thereto a new section, designated §33-16D-17, all relating to autism spectrum disorder; requiring coverage for early detection, diagnosis and treatment of autism spectrum disorder by all insurance policies and insurance plans provided by the West Virginia Public Employees Insurance Act, all accident and sickness policies, all group accident and sickness policies, all small employer accident and sickness policies and all plans for health services or accident or sickness insurance provided by the West Virginia Children’s Health Insurance Program which provides coverage for hospital, surgical or medical care coverage in the state; providing requirements and limitations on required coverage; exceptions; and providing that the provisions of this bill be known and cited collectively as the ‘Cameron and Dominic Law’.

Be it enacted by the Legislature of West Virginia:

    That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §5-16-7f; that said code be amended by adding thereto a new section, designated §5-16B-6e; that said code be amended by adding thereto a new section, designated §33-15-22; that said code be amended by adding thereto a new section, designated §33-16-18; and that said code be amended by adding thereto a new section, designated §33-16D-17, all to read as follows:

CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.

§5-16-7f. Required coverage for autism spectrum disorder.

    (a) Every policy of insurance or insurance plan provided in the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the State of West Virginia shall include full coverage for early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:

    (1) Every policy must provide full in-state or in-network coverage for early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out-of-state provider.

    (2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six years of age.

    (3) Coverage for behavioral therapy may not exceed a $50,000 maximum benefit per child per year.

    (4) Coverage shall be provided for up to four visits, or consultations, with a certified nutritionist per year.

    (5) Treatment approved by the Federal Drug Administration autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider.

    (6) All prescription medications for autism spectrum disorder shall be covered by the policy.

    (7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.

    (8) Coverage for all medical testing performed on an individual diagnosed with autism spectrum disorder will be provided in full when recommended, or prescribed, by a treating physician or health care provider.

    (9) No visitation limits may be imposed for occupational, physical and speech therapy.

    (10) No visitation limits may be imposed for appointments with a treating physician or health care provider.

    (b) For purposes of this section, “autism spectrum disorder” means one or more or a combination of the following neurobiological conditions: Autism, Asperger Syndrome, Retts Syndrome, or Pervasive Development Disorder.

ARTICLE 16B. WEST VIRGINIA CHILDREN’S HEALTH INSURANCE PROGRAM.

§5-16B-6e. Required coverage for autism spectrum disorder.

    (a) Every policy of insurance or insurance plan provided in the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the State of West Virginia shall include full coverage for early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:

    (1) Every policy must provide full in-state or in-network coverage for early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out-of-state provider.

    (2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder regardless of age.

    (3) Coverage for behavioral therapy may not exceed a $50,000 maximum benefit per child per year.

    (4) Coverage shall be provided for up to four visits, or consultations, with a certified nutritionist per year.

    (5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider.

    (6) All prescription medications for autism spectrum disorder shall be covered by the policy.

    (7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.

    (8) Coverage for all medical testing performed on an individual diagnosed with autism spectrum disorder will be provided in full when recommended, or prescribed, by a treating physician or health care provider.

    (9) No visitation limits may be imposed for occupational, physical and speech therapy.

    (10) No visitation limits may be imposed for appointments with a treating physician or health care provider.

    (b) For purposes of this section, “autism spectrum disorder” means one or more or a combination of the following neurobiological conditions: Autism, Asperger Syndrome, Retts Syndrome, or Pervasive Development Disorder.

CHAPTER 33. INSURANCE.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-22. Required policy coverage for autism spectrum disorder.

    (a) Every policy of insurance or insurance plan provided in the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the State of West Virginia shall include full coverage for early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:

    (1) Every policy must provide full in-state or in-network coverage for early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out-of-state provider.

    (2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six years of age.

    (3) Coverage for behavioral therapy may not exceed a $50,000 maximum benefit per child per year.

    (4) Coverage shall be provided for up to four visits, or consultations, with a certified nutritionist per year.

    (5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider.

    (6) All prescription medications for autism spectrum disorder shall be covered by the policy.

    (7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.

    (8) Coverage for all medical testing performed on an individual diagnosed with autism spectrum disorder will be provided in full when recommended, or prescribed, by a treating physician or health care provider.

    (9) No visitation limits may be imposed for occupational, physical and speech therapy.

    (10) No visitation limits may be imposed for appointments with a treating physician or health care provider.

    (b) For purposes of this section, “autism spectrum disorder” means one or more or a combination of the following neurobiological conditions: Autism, Asperger Syndrome, Retts Syndrome, or Pervasive Development Disorder.

    (c) Notwithstanding any provision of this code to the contrary, this section, together with section seven-f, article sixteen, chapter five of this code, section six-e, article sixteen, chapter five of this code, section eighteen, article sixteen, chapter thirty-three and section seventeen, article sixteen, chapter thirty-three of this code is known as and may be collectively cited as “Cameron and Dominic’s Law”.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-18. Required policy coverage for autism spectrum disorder.

    (a) Every policy of insurance or insurance plan provided in the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the State of West Virginia shall include full coverage for early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:

    (1) Every policy must provide full in-state or in-network coverage for early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out-of-state provider.

    (2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six years of age.

    (3) Coverage for behavioral therapy may not exceed a $50,000 maximum benefit per child per year.

    (4) Coverage shall be provided for up to four visits, or consultations, with a certified nutritionist per year.

    (5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider.

    (6) All prescription medications for autism spectrum disorder shall be covered by the policy.

    (7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.

    (8) Coverage for all medical testing performed on an individual diagnosed with autism spectrum disorder will be provided in full when recommended, or prescribed, by a treating physician or health care provider.

    (9) No visitation limits may be imposed for occupational, physical and speech therapy.

    (10) No visitation limits may be imposed for appointments with a treating physician or health care provider.

    (b) For purposes of this section, “autism spectrum disorder” means one or more or a combination of the following neurobiological conditions: Autism, Asperger Syndrome, Retts Syndrome, or Pervasive Development Disorder.

ARTICLE 16D. MARKETING AND RATE PRACTICES FOR SMALL EMPLOYER                  ACCIDENT AND SICKNESS INSURANCE POLICIES.

§33-16D-17. Required policy coverage for autism spectrum disorder.

    (a) Every policy of insurance or insurance plan provided in the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the State of West Virginia shall include full coverage for early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:

    (1) Every policy must provide full in-state or in-network coverage for early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out-of-state provider.

    (2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six years of age.

    (3) Coverage for behavioral therapy may not exceed a $50,000 maximum benefit per child per year.

    (4) Coverage shall be provided for up to four visits, or consultations, with a certified nutritionist per year.

    (5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider.

    (6) All prescription medications for autism spectrum disorder shall be covered by the policy.

    (7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.

    (8) Coverage for all medical testing performed on an individual diagnosed with autism spectrum disorder will be provided in full when recommended, or prescribed, by a treating physician or health care provider.

    (9) No visitation limits may be imposed for occupational, physical and speech therapy.

    (10) No visitation limits may be imposed for appointments with a treating physician or health care provider.

    (b) For purposes of this section, “autism spectrum disorder” means one or more or a combination of the following neurobiological conditions: Autism, Asperger Syndrome, Retts Syndrome, or Pervasive Development Disorder.



    NOTE: The purpose of this bill is to provide insurance for the detection and treatment of autism.


    Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.

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