An Act To Reform Insurance Coverage To Include Diagnosis and Treatment for Autism Spectrum Disorders
Sec. 1. 24 MRSA §2317-B, sub-§12-F is enacted to read:
Sec. 2. 24-A MRSA §2766 is enacted to read:
§ 2766. Coverage for the diagnosis and treatment of autism spectrum disorders
(1) Habilitative or rehabilitative services, including applied behavior analysis or other professional or counseling services necessary to develop, maintain and restore the functioning of an individual to the extent possible. To be eligible for coverage, applied behavior analysis must be provided by a person professionally certified by a national board of behavior analysts or performed under the supervision of a person professionally certified by a national board of behavior analysts;
(2) Counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker; and
(3) Therapy services provided by a licensed or certified speech therapist, occupational therapist or physical therapist.
Sec. 3. 24-A MRSA §2847-R is enacted to read:
§ 2847-R. Coverage for the diagnosis and treatment of autism spectrum disorders
(1) Habilitative or rehabilitative services, including applied behavior analysis or other professional or counseling services necessary to develop, maintain and restore the functioning of an individual to the extent possible. To be eligible for coverage, applied behavior analysis must be provided by a person professionally certified by a national board of behavior analysts or performed under the supervision of a person professionally certified by a national board of behavior analysts;
(2) Counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker; and
(3) Therapy services provided by a licensed or certified speech therapist, occupational therapist or physical therapist.
Sec. 4. 24-A MRSA §4258 is enacted to read:
§ 4258. Coverage for the diagnosis and treatment of autism spectrum disorders
(1) Habilitative or rehabilitative services, including applied behavior analysis or other professional or counseling services necessary to develop, maintain and restore the functioning of an individual to the extent possible. To be eligible for coverage, applied behavior analysis must be provided by a person professionally certified by a national board of behavior analysts or performed under the supervision of a person professionally certified by a national board of behavior analysts;
(2) Counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker; and
(3) Therapy services provided by a licensed or certified speech therapist, occupational therapist or physical therapist.
Sec. 5. Bureau of Insurance report. The Department of Professional and Financial Regulation, Bureau of Insurance shall review and evaluate the financial impact, social impact and medical efficacy of the mandated health insurance benefit required in this Act after its enactment in the same manner as required for proposed mandated health benefits legislation in the Maine Revised Statutes, Title 24A, section 2752. The bureau shall also compare the projected cost impact of this mandated benefit prior to enactment and the actual cost impact of the mandated benefit based on premium information after enactment. As part of its assessment of the financial impact of the mandate, the bureau shall analyze the number of children receiving coverage under the mandated benefit, the costs of treatment services for autism spectrum disorders, including applied behavior analysis, and the extent to which the requirement for coverage of applied behavior analysis has affected the actual cost impact of the mandated benefit on health insurance premiums. The bureau shall contract within the bureau's existing budgeted resources for any necessary consulting and actuarial expertise to complete the report required by this section. The bureau shall submit a report, including any recommendations for legislation, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters no later than February 1, 2015. The joint standing committee of the Legislature having jurisdiction over insurance and financial services matters may report out a bill based on the report to the First Regular Session of the 127th Legislature.
Sec. 6. Application. The requirements of this Act apply to all policies, contracts and certificates subject to this Act that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2011. For purposes of this Act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.