Bill Text: MN HF1071 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Autism spectrum disorder coverage provided.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Introduced - Dead) 2012-03-19 - Author added Benson, J. [HF1071 Detail]
Download: Minnesota-2011-HF1071-Introduced.html
1.2relating to insurance; providing coverage for autism spectrum disorders;
1.3proposing coding for new law in Minnesota Statutes, chapter 62A.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
1.6 Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
1.7this subdivision have the meanings given.
1.8(b) "Autism spectrum disorder" means the following conditions as determined by
1.9criteria set forth in the most recent edition of the Diagnostic and Statistical Manual of
1.10Mental Disorders of the American Psychiatric Association:
1.11(1) autism or autistic disorder;
1.12(2) Asperger's syndrome; or
1.13(3) pervasive developmental disorder, not otherwise specified.
1.14(c) "Board-certified behavior analyst" means an individual certified by the Behavior
1.15Analyst Certification Board as a board-certified behavior analyst.
1.16(d) "Evidence-based," for purposes of this section only, is as described in subdivision
1.172, paragraph (c), clause (2).
1.18(e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
1.19(f) "Manualized approach" means a self-contained volume, text, or set of
1.20instructional media, which may include videos or compact discs, that codifies in
1.21reasonable detail the procedures for implementing treatment.
1.22(g) "Medical necessity" or "medically necessary care" has the meaning given in
1.23section 62Q.53, subdivision 2.
2.1(h) "Mental health professional" has the meaning given in section 245.4871,
2.2subdivision 27, clauses (1) to (6).
2.3(i) "Qualified mental health behavioral aide" means a mental health behavioral aide
2.4as defined in section 256B.0943, subdivision 7.
2.5(j) "Qualified mental health practitioner" means a mental health practitioner as
2.6defined in section 245.4871, subdivision 26.
2.7(k) "Statistically superior outcomes" means a research study in which the probability
2.8that the results would be obtained under the null hypothesis is less than five percent.
2.9 Subd. 2. Coverage required. (a) For coverage requirements to apply, an individual
2.10must have a diagnosis of autism spectrum disorder made through an evaluation of the
2.11patient, completed within six months prior to the start of treatment, which includes all of
2.12the following:
2.13(1) a complete medical and psychological evaluation performed by a licensed
2.14physician and psychologist using empirically validated tools or tests that incorporate
2.15measures for intellectual functioning, language development, adaptive skills, and
2.16behavioral problems, which must include:
2.17(i) a developmental history of the child, focusing on developmental milestones
2.18and delays;
2.19(ii) a family history, including whether there are other family members with an
2.20autism spectrum disorder, developmental disability, fragile X syndrome, or tuberous
2.21sclerosis;
2.22(iii) a medical history, including signs of deterioration, seizure activity, brain injury,
2.23and head circumference;
2.24(iv) a physical examination completed within the past 12 months;
2.25(v) an evaluation for intellectual functioning;
2.26(vi) a lead screening for those children with a developmental disability; and
2.27(vii) other evaluations and testing as indicated by the medical evaluation, which
2.28may include neuropsychological testing, occupational therapy, physical therapy, family
2.29functioning, genetic testing, imaging laboratory tests, and electrophysiological testing;
2.30(2) a communication assessment conducted by a speech pathologist; and
2.31(3) a comprehensive hearing test conducted by an audiologist. An audiologist with
2.32experience in testing very young children must conduct the test if an audiologist with this
2.33experience is available.
2.34(b) A health plan must provide coverage for the diagnosis, evaluation, assessment,
2.35and medically necessary care of autism spectrum disorders that is evidence-based,
2.36including but not limited to:
3.1(1) neurodevelopmental and behavioral health treatments, instruction, and
3.2management;
3.3(2) applied behavior analysis and intensive early intervention services, including
3.4service package models such as intensive early intervention behavior therapy services
3.5and Lovaas therapy;
3.6(3) speech therapy;
3.7(4) occupational therapy;
3.8(5) physical therapy; and
3.9(6) prescription medications.
3.10(c) Coverage required under this section must include treatment that is in accordance
3.11with:
3.12(1) an individualized treatment plan prescribed by the insured's treating physician or
3.13mental health professional as defined in this section; and
3.14(2) medically and scientifically accepted evidence that meets the criteria of a
3.15peer-reviewed, published study that is one of the following:
3.16(i) a randomized study with adequate statistical power, including a sample size of
3.1730 or more for each group, that shows statistically superior outcomes to a pill placebo
3.18group, psychological placebo group, another treatment group, or a wait list control group,
3.19or that is equivalent to another evidence-based treatment that meets the above standard
3.20for the specified problem area;
3.21(ii) a series of at least three single-case design experiments with clear specification
3.22of the subjects and with clear specification of the treatment approach that:
3.23(A) use robust experimental designs;
3.24(B) show statistically superior outcomes to pill placebo, psychological placebo,
3.25or another treatment group; and
3.26(C) either use a manualized approach or are conducted by at least two independent
3.27investigators or teams.
3.28Where evidence meeting the standards of this subdivision does not exist for the
3.29treatment of a diagnosed condition or for an individual matching the demographic
3.30characteristics for which the evidence is valid, coverage required under this section must
3.31include treatment that is in accordance with practice guidelines based on consensus of
3.32Minnesota health care professionals knowledgeable in the treatment of individuals with
3.33autism spectrum disorders.
3.34(d) Early intensive behavior therapies that meet the criteria set forth in paragraphs
3.35(b) and (c) must also meet the following best practices standards:
4.1(1) the services must be prescribed by a mental health professional as an appropriate
4.2treatment option for the individual child;
4.3(2) regular reporting of services provided and the child's progress must be submitted
4.4to the prescribing mental health professional;
4.5(3) care must include appropriate parent or legal guardian education and
4.6involvement;
4.7(4) the medically prescribed treatment and frequency of services should be
4.8coordinated between the school and provider for all children up to age 21; and
4.9(5) services must be provided by a mental health professional or, as appropriate, a
4.10board-certified behavior analyst, a qualified mental health practitioner, or a qualified
4.11mental health behavioral aide.
4.12(e) Providers under this section must work with the commissioner in implementing
4.13evidence-based practices and, specifically for children under age 21, the Minnesota
4.14Evidence-Based Practice Database of research-informed practice elements and specific
4.15constituent practices.
4.16(f) A health plan company may not refuse to renew or reissue, or otherwise terminate
4.17or restrict coverage of an individual solely because the individual is diagnosed with an
4.18autism spectrum disorder.
4.19(g) A health plan company may request an updated treatment plan only once every
4.20six months, unless the health plan company and the treating physician or mental health
4.21professional agree that a more frequent review is necessary due to emerging circumstances.
4.22 Subd. 3. Supervision of certain practitioners, analysts, and aides. A mental
4.23health professional who uses the services of a qualified mental health practitioner,
4.24board-certified behavior analyst, or qualified mental health behavioral aide for the
4.25purpose of assisting in the provision of services to patients who have autism spectrum
4.26disorder is responsible for functions performed by these service providers. The qualified
4.27mental health professional must maintain clinical supervision of services the professional
4.28provides and accept full responsibility for his or her actions. The services provided
4.29must be medically necessary and identified in the child's individual treatment plan.
4.30Service providers must document their activities in written progress notes that reflect
4.31implementation of the individual treatment plan.
4.32 Subd. 4. State health care programs. This section does not affect benefits
4.33available under the medical assistance, MinnesotaCare, and general assistance medical
4.34care programs. These programs must maintain current levels of coverage, and section
4.35256B.0644 shall continue to apply. The state employee group insurance plan is not subject
4.36to this section until January 1, 2014, but must fully comply with this section on and after
5.1that date. The commissioner shall monitor these services and report to the chairs of the
5.2house of representatives and senate standing committees that have jurisdiction over health
5.3and human services by February 1, 2012, whether there are gaps in the level of service
5.4provided by these programs and the state employee group insurance plan, and the level of
5.5service provided by private health plans following enactment of this section.
5.6 Subd. 5. No effect on other law. Nothing in this section limits in any way the
5.7coverage required under sections 62Q.47 and 62Q.53.
5.8EFFECTIVE DATE.This section is effective August 1, 2011, and applies to
5.9coverage offered, issued, sold, renewed, or continued as defined in Minnesota Statutes,
5.10section 60A.02, subdivision 2a, on or after that date.
1.3proposing coding for new law in Minnesota Statutes, chapter 62A.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
1.6 Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
1.7this subdivision have the meanings given.
1.8(b) "Autism spectrum disorder" means the following conditions as determined by
1.9criteria set forth in the most recent edition of the Diagnostic and Statistical Manual of
1.10Mental Disorders of the American Psychiatric Association:
1.11(1) autism or autistic disorder;
1.12(2) Asperger's syndrome; or
1.13(3) pervasive developmental disorder, not otherwise specified.
1.14(c) "Board-certified behavior analyst" means an individual certified by the Behavior
1.15Analyst Certification Board as a board-certified behavior analyst.
1.16(d) "Evidence-based," for purposes of this section only, is as described in subdivision
1.172, paragraph (c), clause (2).
1.18(e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
1.19(f) "Manualized approach" means a self-contained volume, text, or set of
1.20instructional media, which may include videos or compact discs, that codifies in
1.21reasonable detail the procedures for implementing treatment.
1.22(g) "Medical necessity" or "medically necessary care" has the meaning given in
1.23section 62Q.53, subdivision 2.
2.1(h) "Mental health professional" has the meaning given in section 245.4871,
2.2subdivision 27, clauses (1) to (6).
2.3(i) "Qualified mental health behavioral aide" means a mental health behavioral aide
2.4as defined in section 256B.0943, subdivision 7.
2.5(j) "Qualified mental health practitioner" means a mental health practitioner as
2.6defined in section 245.4871, subdivision 26.
2.7(k) "Statistically superior outcomes" means a research study in which the probability
2.8that the results would be obtained under the null hypothesis is less than five percent.
2.9 Subd. 2. Coverage required. (a) For coverage requirements to apply, an individual
2.10must have a diagnosis of autism spectrum disorder made through an evaluation of the
2.11patient, completed within six months prior to the start of treatment, which includes all of
2.12the following:
2.13(1) a complete medical and psychological evaluation performed by a licensed
2.14physician and psychologist using empirically validated tools or tests that incorporate
2.15measures for intellectual functioning, language development, adaptive skills, and
2.16behavioral problems, which must include:
2.17(i) a developmental history of the child, focusing on developmental milestones
2.18and delays;
2.19(ii) a family history, including whether there are other family members with an
2.20autism spectrum disorder, developmental disability, fragile X syndrome, or tuberous
2.21sclerosis;
2.22(iii) a medical history, including signs of deterioration, seizure activity, brain injury,
2.23and head circumference;
2.24(iv) a physical examination completed within the past 12 months;
2.25(v) an evaluation for intellectual functioning;
2.26(vi) a lead screening for those children with a developmental disability; and
2.27(vii) other evaluations and testing as indicated by the medical evaluation, which
2.28may include neuropsychological testing, occupational therapy, physical therapy, family
2.29functioning, genetic testing, imaging laboratory tests, and electrophysiological testing;
2.30(2) a communication assessment conducted by a speech pathologist; and
2.31(3) a comprehensive hearing test conducted by an audiologist. An audiologist with
2.32experience in testing very young children must conduct the test if an audiologist with this
2.33experience is available.
2.34(b) A health plan must provide coverage for the diagnosis, evaluation, assessment,
2.35and medically necessary care of autism spectrum disorders that is evidence-based,
2.36including but not limited to:
3.1(1) neurodevelopmental and behavioral health treatments, instruction, and
3.2management;
3.3(2) applied behavior analysis and intensive early intervention services, including
3.4service package models such as intensive early intervention behavior therapy services
3.5and Lovaas therapy;
3.6(3) speech therapy;
3.7(4) occupational therapy;
3.8(5) physical therapy; and
3.9(6) prescription medications.
3.10(c) Coverage required under this section must include treatment that is in accordance
3.11with:
3.12(1) an individualized treatment plan prescribed by the insured's treating physician or
3.13mental health professional as defined in this section; and
3.14(2) medically and scientifically accepted evidence that meets the criteria of a
3.15peer-reviewed, published study that is one of the following:
3.16(i) a randomized study with adequate statistical power, including a sample size of
3.1730 or more for each group, that shows statistically superior outcomes to a pill placebo
3.18group, psychological placebo group, another treatment group, or a wait list control group,
3.19or that is equivalent to another evidence-based treatment that meets the above standard
3.20for the specified problem area;
3.21(ii) a series of at least three single-case design experiments with clear specification
3.22of the subjects and with clear specification of the treatment approach that:
3.23(A) use robust experimental designs;
3.24(B) show statistically superior outcomes to pill placebo, psychological placebo,
3.25or another treatment group; and
3.26(C) either use a manualized approach or are conducted by at least two independent
3.27investigators or teams.
3.28Where evidence meeting the standards of this subdivision does not exist for the
3.29treatment of a diagnosed condition or for an individual matching the demographic
3.30characteristics for which the evidence is valid, coverage required under this section must
3.31include treatment that is in accordance with practice guidelines based on consensus of
3.32Minnesota health care professionals knowledgeable in the treatment of individuals with
3.33autism spectrum disorders.
3.34(d) Early intensive behavior therapies that meet the criteria set forth in paragraphs
3.35(b) and (c) must also meet the following best practices standards:
4.1(1) the services must be prescribed by a mental health professional as an appropriate
4.2treatment option for the individual child;
4.3(2) regular reporting of services provided and the child's progress must be submitted
4.4to the prescribing mental health professional;
4.5(3) care must include appropriate parent or legal guardian education and
4.6involvement;
4.7(4) the medically prescribed treatment and frequency of services should be
4.8coordinated between the school and provider for all children up to age 21; and
4.9(5) services must be provided by a mental health professional or, as appropriate, a
4.10board-certified behavior analyst, a qualified mental health practitioner, or a qualified
4.11mental health behavioral aide.
4.12(e) Providers under this section must work with the commissioner in implementing
4.13evidence-based practices and, specifically for children under age 21, the Minnesota
4.14Evidence-Based Practice Database of research-informed practice elements and specific
4.15constituent practices.
4.16(f) A health plan company may not refuse to renew or reissue, or otherwise terminate
4.17or restrict coverage of an individual solely because the individual is diagnosed with an
4.18autism spectrum disorder.
4.19(g) A health plan company may request an updated treatment plan only once every
4.20six months, unless the health plan company and the treating physician or mental health
4.21professional agree that a more frequent review is necessary due to emerging circumstances.
4.22 Subd. 3. Supervision of certain practitioners, analysts, and aides. A mental
4.23health professional who uses the services of a qualified mental health practitioner,
4.24board-certified behavior analyst, or qualified mental health behavioral aide for the
4.25purpose of assisting in the provision of services to patients who have autism spectrum
4.26disorder is responsible for functions performed by these service providers. The qualified
4.27mental health professional must maintain clinical supervision of services the professional
4.28provides and accept full responsibility for his or her actions. The services provided
4.29must be medically necessary and identified in the child's individual treatment plan.
4.30Service providers must document their activities in written progress notes that reflect
4.31implementation of the individual treatment plan.
4.32 Subd. 4. State health care programs. This section does not affect benefits
4.33available under the medical assistance, MinnesotaCare, and general assistance medical
4.34care programs. These programs must maintain current levels of coverage, and section
4.35256B.0644 shall continue to apply. The state employee group insurance plan is not subject
4.36to this section until January 1, 2014, but must fully comply with this section on and after
5.1that date. The commissioner shall monitor these services and report to the chairs of the
5.2house of representatives and senate standing committees that have jurisdiction over health
5.3and human services by February 1, 2012, whether there are gaps in the level of service
5.4provided by these programs and the state employee group insurance plan, and the level of
5.5service provided by private health plans following enactment of this section.
5.6 Subd. 5. No effect on other law. Nothing in this section limits in any way the
5.7coverage required under sections 62Q.47 and 62Q.53.
5.8EFFECTIVE DATE.This section is effective August 1, 2011, and applies to
5.9coverage offered, issued, sold, renewed, or continued as defined in Minnesota Statutes,
5.10section 60A.02, subdivision 2a, on or after that date.
