H. B. 2867
(By Delegates Hunt, Webster, Moore, Paxton,
Hatfield, Wooton, Hutchins,
Skaff, Doyle and Wells)
[Introduced February 27, 2009; 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; to amend
said code by adding thereto a new section, designated
§5-16B-6e; to amend said code by adding thereto a new section,
designated §33-15-22; to amend said code by adding thereto a
new section, designated §33
-16-18; and to amend said code 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 provide coverage for hospital, surgical or medical care coverage in the state
; providing
requirements and limitations on required coverage; and
exceptions.
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 for
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 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; and
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(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 plan for health services or accident and sickness
insurance offered or provided pursuant to 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 the 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) The policy or plan 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) Coverage for behavioral therapy may not exceed a $50,000
maximum benefit per year;
(3) Coverage shall be provided for up to four visits, or
consultations, with a certified nutritionist per year;
(4) 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;
(5) All prescription medications for autism spectrum disorder
shall be covered by the plan or policy; and
(6) The plan or policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum
disorder.
(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) The provisions of this section are not applicable to
health care coverage provided by Medicaid.
CHAPTER 33.
INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-22. Required policy coverage for autism spectrum disorder.
(a) Every policy of insurance subject to 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 $75,000
maximum benefit 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; and
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(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 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-18.
Required policy coverage for autism spectrum disorder.
(a) Every policy of insurance subject to 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 $75,000
maximum benefit 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; and
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(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 subject to 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 $75,000
maximum benefit 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; and
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(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.