Revision: May 22, 2010, midnight
HB 569-FN – VERSION ADOPTED BY BOTH BODIES
06Jan2010… 2009-2462h
05/05/10 1906s
2009 SESSION
01/05
HOUSE BILL 569-FN
AN ACT clarifying insurance coverage for diagnosis and treatment of pervasive developmental disorder or autism.
SPONSORS: Rep. Butcher, Ches 3; Rep. Hammond, Hills 3; Sen. Hassan, Dist 23; Sen. Fuller Clark, Dist 24; Sen. Kelly, Dist 10; Sen. Sgambati, Dist 4; Sen. Lasky, Dist 13
COMMITTEE: Commerce and Consumer Affairs
This bill clarifies the insurance coverage required for diagnosis and treatment of pervasive developmental disorder or autism.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
06Jan2010… 2009-2462h
05/05/10 1906s
09-0706
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nine
AN ACT clarifying insurance coverage for diagnosis and treatment of pervasive developmental disorder or autism.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Coverage for Certain Biologically-Based Mental Illnesses. Amend RSA 417-E:1 by inserting after paragraph V the following new paragraph:
VI. Nothing in this section shall be construed to affect any obligation to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals With Disabilities Education Act, or the provision of services to an individual under any other federal or state law.
2 New Section; Coverage for Treatment of Pervasive Developmental Disorder or Autism. Amend RSA 417-E by inserting after section 1 the following new section:
417-E:2 Coverage for Treatment of Pervasive Developmental Disorder or Autism
I. For the purposes of this chapter, treatment of pervasive developmental disorder or autism as required under RSA 417-E:1, III(h) shall include the following:
(a) Professional services and treatment programs, including applied behavioral analysis, necessary to produce socially significant improvements in human behavior or to prevent loss of attained skill or function. To be eligible for coverage, applied behavior analysis must be provided by a person professionally certified by the national Behavior Analyst Certification Board or performed under the supervision of a person professionally certified by the national Behavior Analyst Certification Board.
(b) Prescribed pharmaceuticals subject to the same terms and conditions of the policy as other prescribed pharmaceuticals.
(c) Direct or consultative services provided by a licensed professional including a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, or licensed clinical social worker; and
(d) Services provided by a licensed speech therapist, licensed occupational therapist, or licensed physical therapist.
II. An insurer may require submission of a treatment plan, including the frequency and duration of treatment, signed by the primary care provider, an appropriately credentialed treating specialist, a child psychiatrist, a pediatrician with a specialty in behavioral-developmental pediatrics, a neurologist with a specialty in child neurology, or a licensed psychologist with training in child psychology, that the treatment is medically necessary for the patient and is consistent with nationally recognized treatment standards for the condition such as those set forth by the American Academy of Pediatrics. An insurer may require an updated treatment plan no more frequently than on a semi-annual basis. Coverage shall not be denied on the basis that services are habilitative in nature.
III. The policy, contract, or certificate may limit coverage for applied behavior analysis to $36,000 per year for children 0 to 12 years of age, and $27,000 from ages 13 to 21. An insurer may not apply payments for coverage unrelated to autism spectrum disorders to any maximum benefit established under this paragraph.
IV. Nothing in this section shall be construed to affect any obligation by a school district or the state of New Hampshire to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals With Disabilities Education Act, or the provision of services to an individual under any other federal or state law.
V. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the insurance coverage requirements established under this section.
3 Applicability. This act shall apply to all group policies, contracts, and certificates issued or renewed on or after January 1, 2011.
4 Effective Date.
I. Sections 1 and 2 of this act shall take effect January 1, 2011.
II. The remainder of this act shall take effect upon its passage.
LBAO
09-0706
Amended 03/11/10
HB 569 FISCAL NOTE
AN ACT clarifying insurance coverage for diagnosis and treatment of pervasive developmental disorder or autism.
FISCAL IMPACT:
The Insurance Department states this bill, as amended by the House (Amendment #2010-2462h), will have an indeterminable fiscal impact on state general fund revenue, county expenditures and local expenditures in FY 2011 and each year thereafter. The Department of Health and Human Services states this bill may decrease state expenditures by an indeterminable amount in FY 2011 and each year thereafter. The New Hampshire Association of Counties states this bill will have an indeterminable fiscal impact on county expenditures in FY 2011 and each year thereafter. There is no fiscal impact on county and local revenue.
METHODOLOGY:
The Insurance Department states this bill clarifies insurance coverage for diagnosis and treatment of pervasive developmental disorder or autism. The Department states this bill expands pervasive developmental disorder or autism coverage beyond the requirements of existing mandates for group insurance. The Department estimates group insurance rates may increase by 0.2% to 0.4% or $2 to $4 million for policy holders of fully-insured group policies. Increases in premium rates may increase premium tax revenue. However, the Department indicates it is not able to determine if employers will make insurance purchasing decisions to control costs that would limit increases in premium tax revenue. The Department states this bill will have no impact on state expenditures as the state is self-funded. The Department states this bill will have an indeterminable fiscal impact on county and local expenditures.
The Department of Health and Human Services states this bill expands a mandated insurance benefit for the treatment of autism. The Department states to the extent insurers assume a greater responsibility for autism treatments presently covered by Medicaid and the insurers are third party payors for individuals covered by Medicaid, state expenditures may decrease. The Department is not able to determine any specific expenditure decrease that may result due to the expanded mandate.
The Department of Administrative Services states the state employee health benefit program is self-funded and would not be subject to any expanded coverage requirements resulting from this bill. Therefore, the Department anticipates no fiscal impact on state expenditures.
The New Hampshire Association of Counties states to the extent any health insurance provided to county employees does not currently provide this coverage, insurance premiums may increase, resulting in increased county expenditures. However, because the Association does not have information on the number of counties impacted, the fiscal impact cannot be determined at this time.
The New Hampshire Municipal Association states this bill will have no impact on municipalities.