Summary of 2012 Alaska Autism Insurance Reform Bill:

Senate Bill 74 - Sponsored by State Senator Johnny Ellis (D-Anchorage) House Bill 79 - Sponsored by State Representative Pete Petersen (D-Anchorage)

The bills would:
 

  • Require private health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder
  • Direct that a health care plan may not terminate coverage, or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an enrollee solely because the individual is diagnosed with, or has received treatment for, an autism spectrum disorder
  • Require that coverage be provided only to individuals under 21 years of age
  • Impose no cap on the number of visits to a covered service provider
  • Impose no annual benefit dollar limit
  • Require that coverage not be subject to lifetime maximums, deductibles, copayments, or coinsurance or other terms and conditions that are less favorable than those that apply to physical illness generally under the health plan
  • Direct that coverage of treatments be provided  when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary

Include coverage of the following treatments:

  • Diagnosis
  • Habilitative or rehabilitative care - meaning professional counseling, guidance services, and treatment programs, including applied behavioral analysis (ABA) or other structured behavioral therapies necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care - meaning services provided by or under the supervision of a licensed speech-language pathologist, occupational therapist, or physical therapist
  • Not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan
  • Apply only to state-regulated insurance plans; they do not apply to self-funded insurance plans which are regulated by the federal government under ERISA law
  • Take effect immediately upon enactment and apply to health insurance policies that are offered, issued for delivery, delivered, or renewed on or after January 1, 2012