Vetoed by Governor Bob McDonnell

Vote Smart's Synopsis:

Vote to pass a bill requiring health insurance providers to cover children born with autism.

Highlights:

• Requires each health maintenance organization providing a health care plan for health care services to provide coverage for the diagnosis of autism spectrum disorder and the treatment of the disorder for individuals between 2 and 6 years old (Sec. 1).

• Prohibits health insurance providers from terminating coverage or refusing to deliver, issue, amend, adjust, or renew coverage of an individual solely because the individual is diagnosed with autism disorder (Sec.1).

• Authorizes the health insurance provider to request a review of treatment for those insured and diagnosed with autism 1 time every 12 months (Sec. 1).

• Prohibits placing visit limits on an insured diagnosed with autism (Sec. 1).

• Prohibits insurance providers from using procedures other than those deemed customary to determine the appropriateness of, and medical necessity for, treatment of autism, provided that all medical determinations have been made in the same manner as those for the treatment of any other illness, condition, or disorder (Sec. 1).

• Specifies that the provisions of this act do not include the following (Sec. 1):
• Short-term travel, accident-only, limited, or specified disease policies;
• Short-term nonrenewable policies for not more than 6 months' duration;
• Policies, contracts, or plans issued in the individual market or small group markets to employers with 50 or fewer employees; or
• Policies or contracts designed for issuance to person eligible for coverage under Medicare, or any other comparable federal government plan.

• Specifies that the bill will apply to all insurance policies, subscription contracts and health care plans delivered, issued for delivery, reissued, or extended as well as all such policies, contract, or plans for which a term is changed or any premium adjustment is made on or after January 1, 2012 (Sec. 1).

• Requires that autism be covered in the health insurance plans of state employees as well as health insurance plans offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, teachers, and retirees (Sec. 1).

• Specifies that an insurer, cooperation, health maintenance organization, or a governmental entity providing coverage is exempt from providing coverage for behavioral health treatment (Sec. 1).

• Authorizes an actuary who is affiliated with the insurer and who is a member and meets the standards of the American Academy of Actuaries to certify the costs associated with coverage of behavioral health treatment not more than once a year (Sec. 1).

• Requires an insurance provider to provide benefits of $35,000 for autism unless the provider elects to provide more (Sec. 1).

• Defines the following terms (Sec. 1):
• "Applied behavior analysis" means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior;
• "Autism spectrum disorder" means any pervasive developmental disorder, including autistic disorder, Aspergers Syndrome, Rett syndrome, childhood disintegrative disorder, or Pervasive Developmental Disorder;
• "Diagnosis of autism spectrum disorder" means medically necessary assessments, evaluations, or tests to diagnose whether an individual has an autism spectrum disorder;
• "Treatment for autism spectrum disorder" shall be identified in a treatment plan and includes care prescribed or ordered for an individual diagnosed with autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary; and
• "Treatment plan" means a plan for the treatment of autism spectrum disorder developed by a licensed physician or a licensed psychologist pursuant to a comprehensive evaluation or reevaluation performed in a manner consistent with the most recent clinical report or recommendation of the American Academy of Pediatrics or the American Academy of Child and Adolescent Psychiatry.

• Senator Wagner stated that he was recorded as not voting on the question of agreeing to the substitute proposed by the House of Delegates, whereas he intended to vote nay.

Full Bill Text

Vote Smart's Synopsis:

Vote to concur with House amendments and pass a bill requiring health insurance providers to cover children born with autism.

Highlights:

• Requires each health maintenance organization providing a health care plan for health care services to provide coverage for the diagnosis of autism spectrum disorder and the treatment of the disorder for individuals between 2 and 6 years old (Sec. 1).

• Prohibits health insurance providers from terminating coverage or refusing to deliver, issue, amend, adjust, or renew coverage of an individual solely because the individual is diagnosed with autism disorder (Sec.1).

• Authorizes the health insurance provider to request a review of treatment for those insured and diagnosed with autism 1 time every 12 months (Sec. 1).

• Prohibits placing visit limits on an insured diagnosed with autism (Sec. 1).

• Prohibits insurance providers from using procedures other than those deemed customary to determine the appropriateness of, and medical necessity for, treatment of autism, provided that all medical determinations have been made in the same manner as those for the treatment of any other illness, condition, or disorder (Sec. 1).

• Specifies that the provisions of this act do not include the following (Sec. 1):
• Short-term travel, accident-only, limited, or specified disease policies;
• Short-term nonrenewable policies for not more than 6 months' duration;
• Policies, contracts, or plans issued in the individual market or small group markets to employers with 50 or fewer employees; or
• Policies or contracts designed for issuance to person eligible for coverage under Medicare, or any other comparable federal government plan.

• Specifies that the bill will apply to all insurance policies, subscription contracts and health care plans delivered, issued for delivery, reissued, or extended as well as all such policies, contract, or plans for which a term is changed or any premium adjustment is made on or after January 1, 2012 (Sec. 1).

• Requires that autism be covered in the health insurance plans of state employees as well as health insurance plans offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, teachers, and retirees (Sec. 1).

• Specifies that an insurer, cooperation, health maintenance organization, or a governmental entity providing coverage is exempt from providing coverage for behavioral health treatment (Sec. 1).

• Authorizes an actuary who is affiliated with the insurer and who is a member and meets the standards of the American Academy of Actuaries to certify the costs associated with coverage of behavioral health treatment not more than once a year (Sec. 1).

• Requires an insurance provider to provide benefits of $35,000 for autism unless the provider elects to provide more (Sec. 1).

• Defines the following terms (Sec. 1):
• "Applied behavior analysis" means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior;
• "Autism spectrum disorder" means any pervasive developmental disorder, including autistic disorder, Aspergers Syndrome, Rett syndrome, childhood disintegrative disorder, or Pervasive Developmental Disorder;
• "Diagnosis of autism spectrum disorder" means medically necessary assessments, evaluations, or tests to diagnose whether an individual has an autism spectrum disorder;
• "Treatment for autism spectrum disorder" shall be identified in a treatment plan and includes care prescribed or ordered for an individual diagnosed with autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary; and
• "Treatment plan" means a plan for the treatment of autism spectrum disorder developed by a licensed physician or a licensed psychologist pursuant to a comprehensive evaluation or reevaluation performed in a manner consistent with the most recent clinical report or recommendation of the American Academy of Pediatrics or the American Academy of Child and Adolescent Psychiatry.

• Senator Wagner stated that he was recorded as not voting on the question of agreeing to the substitute proposed by the House of Delegates, whereas he intended to vote nay.

Full Bill Text