PA 08-132—sHB 5696

Insurance and Real Estate Committee

AN ACT REQUIRING INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER THERAPIES

SUMMARY: This act requires health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2009 to cover physical, speech, and occupational therapy services provided to treat autism spectrum disorders if the policies cover these services for other diseases and conditions. It defines “autism spectrum disorder” based on the American Psychiatric Association's most recent Diagnostic and Statistical Manual of Mental Disorders.

It applies this requirement to group and individual (1) health insurance policies that cover basic hospital, medical-surgical, or major medical expenses; (2) HMO contracts covering hospital and medical expenses; and (3) hospital or medical service contracts. Due to federal preemption, this requirement does not apply to self-insured plans.

EFFECTIVE DATE: January 1, 2009

BACKGROUND

Autism Spectrum Disorder

The American Psychiatric Association's most recent Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR (fourth edition, text revision), refers to autism as a pervasive developmental disorder, more often referred to today as autism spectrum disorder (ASD). ASD ranges from a severe form, called autistic disorder, to a milder form, Asperger syndrome. If a child has symptoms of either but does not meet the specific diagnostic criteria, the diagnosis is called pervasive developmental disorder not otherwise specified. Other rare, very severe disorders that ASD includes are Rett syndrome and childhood disintegrative disorder.

Related Laws

Mental Disorders. Under Connecticut law, insurance must cover the diagnosis and treatment of mental or nervous conditions. It defines “mental or nervous conditions” as mental disorders, as it is used in the DSM-IV-TR. It specifically excludes (1) mental retardation; (2) learning, motor skills, communication, and caffeine-related disorders; (3) relational problems; and (4) additional conditions not otherwise defined as mental disorders in the DSM-IV-TR (CGS 38a-488a and 38a-514).

Birth-to-Three. Insurance must cover medically necessary early intervention services for a child from birth until age three that are part of an individualized family service plan. Coverage is limited to $3,200 per child per year, up to $9,600 for the three years (CGS 38a-490a and 38a-516a).

Occupational Therapy. Insurance must cover occupational therapy if the policy covers physical therapy (CGS 38a-496 and 38a-524).

OLR Tracking: JLK: JK: SS: ts