AN ACT TO PROVIDE COVERAGE FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS. Enacted October 15, 2015. Effective July 1, 2016.
Summary date: Oct 26 2015 - View summary
Summary date: Sep 28 2015 - View summary
House amendment makes the following changes to the 2nd edition.
Amends proposed GS 58-3-192(g), deleting language that defines a "non-grandfathered health plan" as a health plan not included in the plans defined under GS 58-50-110(10a).
Deletes the proposed language found in GS 58-3-192(i) and replaces it with language that requires all health benefit plans, except as specified in subsection (c) (which concerns coverage for adaptive behavior treatment), to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder in accordance with standards as specified in the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Amends the effective date of the act, providing that the act becomes effective July 1, 2016 (previously, effective January 1, 2016).
Summary date: Apr 23 2015 - View summary
Senate committee substitute makes the following changes to the 1st edition.
Amends GS 58-3-192 as follows. Amends the definition of adaptive behavior treatment to amend the conditions that must be met to add a licensed professional counselor and a licensed marriage and family therapist to those providers that may provide or supervise the treatment. Also adds licensed marriage and family therapists to those professionals that may provide services meeting the definition of therapeutic care. Allows coverage for adaptive behavior treatment to be limited to individuals 18 or younger (was, health benefit plans must provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder for individuals 18 or younger). Adds a provision requiring the maximum benefit amount, beginning in 2017, to be indexed using the Consumer Price Index for All Urban Consumers for the South Region. Requires the amount to be posted by April 1 of each year and applies to policies renewed or purchased the following calendar year. Deletes the provision prohibiting coverage from being subject to any limits on the number of visits an individual may have for treatment of autism spectrum disorder. Makes additional clarifying and technical changes.
Makes technical changes throughout.
Changes the act's effective date from October 1, 2015, to January 1, 2016.
Summary date: Mar 31 2015 - View summary
Amends GS 58-3-220 to amend the definition of mental illness, as it applies to the statute governing mental illness benefits coverage, to include mental disorders defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM‑V (was, DSM-IV), and adds to the exclusions those coded as autism spectrum disorders (299.00). Makes conforming changes.
Enacts new GS 58-3-192, requiring health benefit plans to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder for individuals 18 years of age or younger. Prohibits an insurer from terminating coverage or refusing to issue, amend, or renew coverage to an individual solely because the individual is diagnosed with autism spectrum disorder or has received treatment for autism spectrum disorder. Prohibits limiting the number of visits an individual may have for treatment of autism spectrum disorder and allows coverage for adaptive behavior treatments to be limited to a maximum benefit of up $40,000 per year.
Provides that coverage may be subject to co‑payment, deductible, and coinsurance provisions of a health benefit plan that are not less favorable than the co‑payment, deductible, and coinsurance provisions that apply to substantially all medical services covered by the health benefit plan.
Makes conforming changes to GS 58-51-55, GS 58-67-75, and GS 58-65-90.
Applies to insurance contracts issued, renewed, or amended on or after October 1, 2015.