PRINTER'S NO. 656
No. 605 Session of 2007
INTRODUCED BY ORIE, ERICKSON, RAFFERTY, BOSCOLA, MUSTO, FONTANA, C. WILLIAMS, BROWNE, COSTA, KITCHEN, RHOADES, WOZNIAK, LOGAN AND WONDERLING, MARCH 20, 2007
REFERRED TO BANKING AND INSURANCE, MARCH 20, 2007
AN ACT 1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An 2 act relating to insurance; amending, revising, and 3 consolidating the law providing for the incorporation of 4 insurance companies, and the regulation, supervision, and 5 protection of home and foreign insurance companies, Lloyds 6 associations, reciprocal and inter-insurance exchanges, and 7 fire insurance rating bureaus, and the regulation and 8 supervision of insurance carried by such companies, 9 associations, and exchanges, including insurance carried by 10 the State Workmen's Insurance Fund; providing penalties; and 11 repealing existing laws," providing for autism spectrum 12 disorders coverage. 13 The General Assembly of the Commonwealth of Pennsylvania 14 hereby enacts as follows: 15 Section 1. The act of May 17, 1921 (P.L.682, No.284), known 16 as The Insurance Company Law of 1921, is amended by adding a 17 section to read: 18 Section 635.2. Autism Spectrum Disorders Coverage.--(a) A 19 health insurance policy delivered, issued, executed or renewed 20 by an insurer in this Commonwealth on or after the effective 21 date of this section shall provide coverage for autism spectrum 22 disorders for an individual less than 24 years of age and
1 include coverage for the following care and services: 2 (1) Habilitation care. 3 (2) Psychiatric care. 4 (3) Psychological care. 5 (4) Rehabilitation care. 6 (5) Respite care. 7 (6) Therapeutic care. 8 (b) Coverage provided under this section shall be subject to 9 a maximum of two thousand dollars ($2,000) benefit per month for 10 the covered individual, adjusted annually by the average 11 percentage increase or decrease of private medical insurance 12 premiums each year. This limit shall not apply to the coverage 13 of other health conditions of the individual not related to the 14 treatment of autism spectrum disorders. 15 (c) Coverage under this section shall be subject to 16 copayment, deductible and coinsurance provisions of a health 17 insurance policy to the extent that other medical services 18 covered by the policy are subject to those provisions. 19 (d) This section shall not apply to the following types of 20 policies: 21 (1) Accident only. 22 (2) Limited benefit. 23 (3) Credit. 24 (4) Dental. 25 (5) Vision. 26 (6) Specified disease. 27 (7) Medicare supplement. 28 (8) Civilian Health and Medical Program of the Uniformed 29 Services (CHAMPUS) supplement. 30 (9) Long-term care or disability income. 20070S0605B0656 - 2 -
1 (10) Workers' compensation. 2 (11) Automobile medical payment. 3 (e) As used in this section, the following words and phrases 4 shall have the meanings given to them in this subsection unless 5 the context clearly indicates otherwise: 6 (1) "Autism spectrum disorders" means any of the pervasive 7 developmental disorders as defined by the most recent edition of 8 the Diagnostic and Statistical Manual of Mental Disorders (DSM), 9 including autistic disorder, Rett's disorder, childhood 10 disintegrative disorder, Asperger's disorder and pervasive 11 development disorder not otherwise specified. 12 (2) "Habilitation care" means care designed to assist 13 individuals in acquiring, retaining and improving the self-help, 14 socialization and adaptive skills necessary to reside 15 successfully in home or community-based settings. Habilitation 16 care may be provided for up to 24 hours a day based on the needs 17 of the individual receiving the care and includes, but is not 18 limited to, health, social or home or community-based services 19 or other services needed to insure the optimal functioning of an 20 individual in the individual's home or community-based setting. 21 (3) "Health insurance policy" means any group health, 22 sickness or accident policy or subscriber contract or 23 certificate issued by an insurance entity subject to one of the 24 following: 25 (i) This act. 26 (ii) The act of December 29, 1972 (P.L.1701, No.364), known 27 as the "Health Maintenance Organization Act." 28 (iii) The act of May 18, 1976 (P.L.123, No.54), known as the 29 "Individual Accident and Sickness Insurance Minimum Standards 30 Act." 20070S0605B0656 - 3 -
1 (iv) 40 Pa.C.S. Ch. 61 (relating to hospital plan 2 corporations) or 63 (relating to professional health services 3 plan corporations). 4 (4) "Psychiatric care" means direct or consultative services 5 provided by a psychiatrist licensed in the state in which he or 6 she practices. 7 (5) "Psychological care" means direct or consultative 8 services provided by a licensed psychologist in the state in 9 which he or she practices. 10 (6) "Rehabilitation care" means professional, counseling and 11 guidance services and treatment programs that are necessary to 12 develop, maintain and restore, to the maximum extent 13 practicable, the functioning of an individual. 14 (7) "Respite care" means care furnished in relief of the 15 primary care-giver on an intermittent basis for a limited period 16 to an individual who resides primarily in a private residence 17 when such care will help the individual to continue residing in 18 the private residence. This term shall include nursing care or 19 private nursing care provided on a respite basis. 20 (8) "Therapeutic care" means services provided by licensed 21 or certified speech therapists, occupational therapists, 22 physical therapists or behavioral health specialists. 23 Section 2. This act shall take effect immediately. L28L40JS/20070S0605B0656 - 4 -