A BILL TO BE ENTITLED AN ACT TO REQUIRE HEALTH BENEFIT PLANS, INCLUDING THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES, TO PROVIDE COVERAGE FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS.
House committee substitute makes the following changes to the 2nd edition.
Amends proposed GS 58-3-192 to remove a licensed clinical social worker from the persons recognized to diagnose autism spectrum disorder and whose diagnosis may serve as a basis for ordering medicalcare or equipment for treatment. Limits required coverage undera health benefit plan for the screening, diagnosis, and treatment of an autism spectrum disorderto individuals 23 years of age or younger. Requires that persons must be diagnosed as having an autism spectrum disorder prior to the age of eight to qualify for required health benefit plan coverage under this section. Provides that coverage for behavioral health treatment under this section may be subject to a maximum benefit of up to $36,000 per year (was, $75,000).
Adds two new subsections, (k) and (l), to GS 58-3-192. Subsection (k) directs the Commissioner of Insurance (Commissioner) to grant a waiver to a small employer carrier as defined in GS 58-50-110(23) from the provisions of this section if the small employer carrier demonstrates via actual claims experience that compliance with this section has increased the cost of the health benefit plan by 2.5% or greater in the premium rate charged to a small employer over the most recent calendar year. Subsection (l) requires the Commissioner to grant a waiver to a health benefit plan issuer that can show that the cost of thehealth benefit plan has increased by1% or greater in the premium rate charged under the plan over the most recent calendar year. Effective October 1, 2013.
Requires the Department of theState Treasurer to submit a report to the General Assembly no later than March 1, 2015, and every March 1st subsequently, on the implementation of coverage underthe State Health Plan for Teachers and State Employees as required under this section. Requires the report to contain: (1) total number of insured persons diagnosed with autism spectrum disorder;(2) total costs of all claims paid out in the previous fiscal year for the coverage required by this section;(3) cost of coverage required under this section per insured, per month;and (4) average cost per insured for coverage of any treatment involving applied behavior analysis. Effective January 1, 2014.
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