SCS/SBs 1122 & 789 - This act requires each health carrier to provide coverage for the treatment of autism spectrum disorder. Coverage under the act is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan. Under the act, an insurer shall not deny or refuse to issue coverage on an individual solely because the individual is diagnosed with autism spectrum disorder. The treatment plan shall include all elements necessary for the health benefit plan to appropriately pay claims. The health benefit plan may only request an updated treatment plan once every 6 months from the treating physician to review medical necessity, unless the health benefit plan and the treating physician agree that a more frequent review is necessary due to emerging clinical circumstances.
To be eligible for autism coverage, an individual shall be diagnosed with autism spectrum disorder at age 8 or younger. The coverage provided under this act shall only be provided to any eligible person less than 16 years of age. Coverage for behavioral therapy is subject to a $50,000 maximum benefit per year. The maximum benefit is adjusted annually for inflation.
This act also requires health carriers who sell health benefit plans on a group basis to offer coverage for prosthetic devices. The coverage must be offered in group policies that are delivered, issued for delivery, continued, or renewed in Missouri on or after January 1, 2009. The act requires every health carrier to communicate the availability of that coverage to all enrollees and to all prospective enrollees with whom they are negotiating. Any coverage for prosthetic devices shall include original and replacement devices, as prescribed by a physician and surgeon or doctor of podiatric medicine acting within the scope of his or her license.
This act shall apply to accident-only, vision-only, dental-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited benefit health insurance policies.
STEPHEN J. WITTE