Am. Sub. H. B. No. 8 Summary

• Health insurers offering basic health care services cannot exclude coverage for screening, diagnosis, and treatment of autism spectrum disorders when medically necessary and prescribed by licensed health care professionals.

• Covered services include habilitative/rehabilitative care, pharmacy care, psychiatric care, psychological care, therapeutic care, counseling services, and any additional treatments adopted by the director of mental retardation and developmental disabilities.

• Coverage shall be delineated in a treatment plan with no limits on number or duration of visits except as specified in the plan, subject to standard copayments, deductibles, and coinsurance, with a yearly maximum of $36,000.

• Insurers may request treatment reviews no more than once every six months (unless the patient's physician or psychologist agrees more frequent review is necessary) and must pay for requested reviews; inpatient services are exempt from the six-month review limitation.

• Insurers unable to offer required autism coverage must submit actuarial documentation showing costs increased more than 1% annually and obtain superintendent of insurance approval; this requirement takes effect January 1, 2011.