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Summary of 2012 Hawaii Autism Insurance Reform Bills:

Senate Bill 2631 - Sponsored by Senator Josh Green (D-Kohala/Kona); House Bill 2405 - Sponsored by Representative Chris Lee (D-Kailua)
February 01, 2012

The bills would:

  • Require health insurance companies to provide coverage of the screening, diagnosis and treatment of autism spectrum disorders

 

  • Coverage and unlimited visits for individuals with autism up to age 26 (SB.2631); HB.2405 places no age cap

 

  • Cap coverage for ABA at $50,000 per year

 

  • Require that coverage not be subject to deductibles, copayments, or coinsurance 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, psychologist, or registered nurse practitioner if the care is determined to be medically necessary

Require health insurance companies to provide coverage of the following:

  • Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, or tests to diagnose whether an individual has an autism spectrum disorder
  • Behavioral health treatment - meaning professional, counseling, and guidance services and treatment programs, including behavioral intervention therapy, applied behavioral analysis (ABA), that are 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 licensed speech pathologists, registered occupational therapists, or licensed physical therapists

 

  • 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
  • Apply to health plans issued or renewed in Hawaii after December 31, 2012