Dylan's Law, HB 2727 / SB 2532 is Introduced 1/23/08

Hi Everyone,
Dylan's Law was introduced on January 23, 2008 by Representative Tommy Waters and Senator David Ige.

We want extend our appreciation, and thank them for doing this for us. Please send them a short note or email, and thank them. Their email addresses are listed below.

Representative Tommy Waters repwaters@Capitol.hawaii.gov
Senator David Ige sendige@Capitol.hawaii.gov


Dylan's Law (the Bill) is below

Let's Work Together and make this a Reality and give all families with children with Autism hope for a brighter future. We can make this happen!!


THE SENATE

TWENTY-FOURTH LEGISLATURE, 2008

S.B. NO. 2532

STATE OF HAWAII

JAN 18 2008

A BILL FOR AN ACT

RELATING TO HEALTH INSURANCE.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The purpose of this Act is to ensure the
provision of quality health care procedures for all Hawaii
residents by requiring coverage of and treatment for autism
spectrum disorders.

SECTION 2. Chapter 431, article 10A, Hawaii Revised
Statutes, is amended by adding a new section to be appropriately
designated and to read as follows:

"§43l:lOA-Autism spectrum disorders benefits and
coverage; notice; definitions. (a) Any other law to the
contrary notwithstanding, each employer group health policy,
contract, plan, or agreement issued or renewed in this State
after December 31, 2008, shall provide to the policyholder and
individuals under twenty-one years of age covered under the
policy, contract, plan, or agreement, coverage for the diagnosis
and treatment of autism spectrum disorders.

(b) Every insurer shall provide notice to its
policyholders regarding the coverage required by this section.
The notice shall be in writing and prominently positioned in any

SB LRB 08-0560-l.doc

1

S.B. NO. 2532

literature or correspondence sent to policyholders and shall be
transmitted to policyholders within calendar year 2008 when
annual information is made available to policyholders, or in any
other mailing to policyholders, but in no case later than
December 31, 2008.

(c) Coverage provided under this section shall be subject
to a maximum benefit of $75,000 per year but shall not be
subject to any limits on the number of visits to an autism
service provider. After December 31, 2010, the insurance
commissioner, on an annual basis, shall adjust the maximum
benefit for inflation using the medical care component of the
United States Department of Labor consumer price index for all
urban consumers 021-U). The commissioner shall ~ublish the
adjusted maximum benefit annually no later than April 1 of each
calendar year, which shall apply during the following calendar
year to health insurance policies subject to this section.
Pavments made bv an insurer on behalf of a covered individual
for any care, treatment, intervention, service, or item, the
provision of which was for the treatment of a health condition
unrelated to the covered individual's autism spectrum disorder,
shall not be applied toward any maximum benefit established
under this subsection.

SB LRB 08-0560-1.d0c

S.B. NO. 2532

(d) Coverage under this section shall be subject to co-
payment, deductible, and coinsurance provisions of a health
insurance policy to the extent that other medical services
covered by the policy are subject to these provisions.

(e) This section shall not be construed as limiting
benefits that are otherwise available to an individual under a
health insurance policy.
(f) As used in this section, unless the context clearly
reauires otherwise:

"Applied behavior analysis" means the design,
implementation, and evaluation of environmental modifications,
using behavioral stimuli and consequences, to produce socially
significant improvement in human behavior, including the use of
direct observation, measurement, and functional analysis of the
relations between environment and behavior.

"Autism service providerw means any person, entity, or
group that provides treatment of autism spectrum disorders.

"Autism spectrum disorders" means any of the pervasive
developmental disorders as defined by the most recent edition of
the Diagnostic and Statistical Manual of Mental Disorders,
including autistic disorder, Asperger's disorder, pervasive

SB LRB 08-056O-l.doc

S.B. NO. 2532

developmental disorder not otherwise specified, Rettfs disorder,
and childhood disintegrative disorder.
"Diagnosis of autism spectrum disorders" means medically
necessary assessments, evaluations, or tests conducted to
diagnose whether an individual has an autism spectrum disorder.

"Health insurance policy" means any group health, sickness,
or accident policy or subscriber contract or certificate issued
by an insurance entity subject to this section.

"Medically necessary" means any care, treatment,
intervention, service, or item that is prescribed, provided, or
ordered by a physician, psychologist, or registered nurse
practitioner licensed to practice in this State in accordance
with accepted standards or practice and that is reasonably
expected to accomplish any of the following:

(1) Prevent the onset of an illness, condition, injury, or
disability;
(2) Reduce or ameliorate the physical, mental, or
developmental effects of an illness, condition,
injury, or disability; or
(3) Assist to achieve or maintain maximum functional
capacity in performing daily activities, taking into
account both the functional capacity of the recipient

SB LRB 08-0560-l.doc

S.B. NO. 2532

and those functional capacities that are appropriate
to recipients of care of the same age.

"Pharmacy care" means medications prescribed by a licensed
physician or registered nurse practitioner and any health-
related services that are deemed medically necessary to
determine the need or effectiveness of the medications.

"Psychiatric care" means direct or consultative services
provided by a licensed psychiatrist.

"Psychological care" means direct or consultative services
provided by a licensed psychologist.

"Rehabilitative and habilitative care" means professional,
counseling, and guidance services and treatment programs,
including applied behavior analysis, that are necessary to
develo~, maintain, and restore, to the maximum extent
practicable, the functioning of an individual.

"Therapeutic care" means services provided by licensed
speech pathologists, registered occupational therapists, or
licensed physical therapists.

"Treatmentfor autism spectrum disorders" includes the
Tollowing care prescribed, provided, or ordered for an
individual diagnosed with an autism spectrum disorder by a
licensed physician, psychologist, or registered nurse

SB LRB 08-0560-1.d0c

S.B. NO. 2532

practitioner if the care is determined to be medically
necessary:
(1) Psychiatric care;
(2) Psychological care;
(3) Rehabilitative and habilitative care;
(4) Therapeutic care; and
(5) Pharmacy care. "

SECTION 3. Chapter 432, article 1, ~awaii Revised
Statutes, is amended by adding a new section to be appropriately
designated and to read as follows:

S432 :1-Autism spectrum disorders benefits and

coverage; notice; definitions. --(a) Any other law to the
contrary notwithstanding, each individual and group hospital or
medical service plan, policy, contract, or agreement issued or
renewed in this State after December 31, 2008, shall provide to
the member and individuals under twenty-one years of age covered
under the service plan, policy, contract, or agreement, coverage
for the diaanosis and treatment of autism spectrum disorders.

(b) Every mutual benefit society shall provide notice to
its members regarding the coverage required by this section.
The notice shall be in writing and prominently positioned in any
literature or correspondence sent to members and shall be

SB LRB 08-0560-1.doc

S.B. NO. 2532

transmitted to members within calendar year 2008 when annual
information is made available to members, or in any other
mailing to members, but in no case later than December 31, 2008.

(c) Coverage provided under this section shall be subject
to a maximum benefit of $75,000 per year but shall not be
subject to any limits on the number of visits to an autism
service provider. After December 31, 2010, the insurance
commissioner, on an annual basis, shall adjust the maximum
benefit for inflation using the medical care component of the
United States Department of Labor consumer price index for all
urban consumers (CPI-U). The commissioner shall publish the
adjusted maximum benefit annually no later than April 1 of each
calendar year, which shall apply during the following calendar
year to health insurance policies subject to this section.
Payments made by a mutual benefit society on behalf of a covered
individual for any care, treatment, intervention, service, or
item, the provision of which was for the treatment of a health
condition unrelated to the covered individual's autism spectrum
disorder, shall not be applied toward any maximum benefit
established under this subsection.

(d) Coverage under this section shall be subject to co-
payment, deductible, and coinsurance provisions of a health

SB LRB 08-056O-l.doc

S.B. NO. 2932

insurance policy to the extent that other medical services
covered by the policy are subject to these provisions.

(e) This section shall not be construed as limitins
benefits that are otherwise available to an individual under a
health insurance policy.

(f) As used in this section, unless the context clearly
requires otherwise:

"Applied behavior analysis" means the design,
imnlementation, and evaluation of environmental modifications,
using behavioral stimuli and consequences, to produce socially
significant improvement in human behavior, including the use of
direct observation, measurement, and functional analysis of the
relations between environment and behavior.

"Autism service providert' means any person, entity, or
group that provides treatment of autism spectrum disorders.

"Autism spectrum disorders" means any of the pervasive
developmental disorders as defined by the most recent edition of
the Diagnostic and Statistical Manual of Mental Disorders,
including autistic disorder, Asperger's disorder, pervasive
develonmental disorder not otherwise s~ecified, Rett's disorder,
and childhood disintegrative disorder.

SB LRB 08-O56O-l.doc

S.B. NO. 2532

"Diagnosis of autism spectrum disordersi1 means medically
necessary assessments, evaluations, or tests conducted to
diagnose whether an individual has an autism spectrum disorder.

"Health insurance policy" means any group health, sickness,
or accident policy or subscriber contract or certificate issued
by a mutual benefit society subject to this section.

"Medically necessary" means any care, treatment,
intervention, service or item that is prescribed, provided, or
ordered by a physician, psychologist, or registered nurse
practitioner licensed to practice in this State in accordance
with accepted standards or practice and that is reasonably
expected to accomplish any of the following:

(1) Prevent the onset of an illness, condition, injury, or
disability;
(2) Reduce or ameliorate the physical, mental, or
developmental effects of an illness, condition,
injury, or disability; or
(3) Assist to achieve or maintain maximum functional
capacity in performing daily activities, taking into
account both the functional capacity of the recipient
and those functional capacities that are appropriate
to recipients of care of the same age.

SB LRB 08-056O-l.doc

"Pharmacy care" means medications prescribed by a licensed
physician or registered nurse practitioner and any health-
related services that are deemed medically necessary to
determine the need or effectiveness of the medications.

"Psvchiatric care" means direct or consultative services
provided by a licensed psychiatrist.
"Psychological care" means direct or consultative services
provided by a licensed psychologist.

"Rehabilitative care" means professional, counseling, and
guidance services and treatment programs, including applied
behavior analysis, that are necessary to develop, maintain, and
restore, to the maximum extent practicable, the functioning of
an individual.

"Therapeutic care" means services provided by licensed
speech pathologists, registered occupational therapists, or
licensed physical therapists.

"Treatment for autism spectrum disorders" includes the
following care prescribed, provided, or ordered for an
individual diagnosed with an autism spectrum disorder by a
licensed physician, psychologist, or registered nurse
practitioner if the care is determined to be medically
necessarv:

SB LRB 08-O56O-l.doc

S.B. NO. 2532

(1) Psychiatric care;
(2) Psychological care;
(3) Rehabilitative care;
(4) Therapeutic care; and
(5) Pharmacy care. "

SECTION 4. Section 4320-23, Hawaii Revised Statutes, is
amended to read as follows:


"S432D-23 Required provisions and benefits.

Notwithstanding any provision of law to the contrary, each
policy, contract, plan, or agreement issued in the State after
January 1, 1995, by health maintenance organizations pursuant to
this chapter, shall include benefits provided in sections
431:lO-212, 431:lOA-115, 431:lOA-115.5, 431:lOA-116, 431:lOA-
116.5, 431:lOA-116.6, 431:lOA-119, 431:lOA-120, [aft$]
431:lOA-121, and 431:lOA- , and chapter 431M."

SECTION 5. The benefit to be provided by health
maintenance organizations corresponding to the benefit provided
under section 431:lOA- , Hawaii Revised Statutes, as contained
in the amendment to section 43213-23, Hawaii Revised Statutes, in
section 4 of this Act, shall take effect for all policies,
contracts, plans, or agreements issued in the State after
December 31, 2008.

SB LRB 08-O56O-l.doc

S.B. NO. 2532

SECTION 6. Statutory material to be repealed is bracketed
and stricken. New statutory material is underscored.
SECTION 7. This Act shall take effect upon its approval.

INTRODUCED BY:


SB LRB 08-0560-l.doc

Report Title:

Mandatory Health Coverage; Autism Spectrum Disorders

Description:

Requires all health insurers, mutual benefit societies, and
health maintenance organizations to provide mandatory coverage
for all policyholders, member, subscribers, and individuals
under age 21 for the diagnosis and treatment of autism spectrum
disorders beginning 1/1/2009.

SB LRB 08-056O-l.doc