H. B. 2858
(By Delegates Rodighiero, Reynolds, Hatfield,
Eldridge, Moore, Barker, Miley, Sobonya,
Guthrie, Webster and Caputo)
[Introduced February 26, 2009; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §5-16-7f; that said
code be amended by adding thereto a new section, designated
§5-16B-6e; that said code be amended by adding thereto a new
section, designated §33-15-22; that said code be amended by
adding thereto a new section, designated §33
-16-18; and that
said code be amended by adding thereto a new section,
designated §33
-16D-17
, all
relating to autism spectrum
disorder; requiring coverage for early detection, diagnosis
and treatment of autism spectrum disorder by all insurance
policies and insurance plans provided by the West Virginia
Public Employees Insurance Act, all accident and sickness
policies, all group accident and sickness policies, all small
employer accident and sickness policies and all plans for
health services or accident or sickness insurance provided by
the West Virginia Children's Health Insurance Program which provides coverage for hospital, surgical or medical care
coverage in the state
; providing requirements and limitations
on required coverage; exceptions; and providing that the
provisions of this bill be known and cited collectively as the
'Cameron and Dominic Law'.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended,
by adding thereto a new section, designated §5-16-7f; that said
code be amended by adding thereto a new section, designated
§5-16B-6e; that said code be amended by adding thereto a new
section, designated §33-15-22; that said code be amended by adding
thereto a new section, designated §33
-16-18; and that said code be
amended by adding thereto a new section, designated §33
-16D-17
, all
to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS;
MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7f. Required coverage for autism spectrum disorder.
(a) Every policy of insurance or insurance plan provided in
the provisions of this article which provides coverage for
hospital, surgical, or medical care coverage in the State of West
Virginia shall include full coverage for early detection, diagnosis
and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and
therapies that are approved by the Federal Drug Administration and
shall meet the following requirements:
(1) Every policy must provide full in-state or in-network
coverage for early detection, diagnosis and treatment of autism
spectrum disorder notwithstanding that the insured is unable to
receive a service, or treatment from an out-of-state provider.
(2) The benefits and coverage must be provided to any person
diagnosed with autism spectrum disorder under twenty-six years of
age.
(3) Coverage for behavioral therapy may not exceed a $50,000
maximum benefit per child per year.
(4) Coverage shall be provided for up to four visits, or
consultations, with a certified nutritionist per year.
(5) Treatment approved by the Federal Drug Administration
autism spectrum disorder will be covered by the policy when
prescribed by a treating physician or health care provider.
(6) All prescription medications for autism spectrum disorder
shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(8) Coverage for all medical testing performed on an
individual diagnosed with autism spectrum disorder will be provided
in full when recommended, or prescribed, by a treating physician or health care provider.
(9) No visitation limits will be imposed for occupational,
physical and speech therapy.
(10) No visitation limits will be imposed for appointments
with a treating physician or health care provider.
(b) For purposes of this section, "autism spectrum disorder"
means one or more or a combination of the following neurobiological
conditions: Autism, Asperger Syndrome, Retts Syndrome, or
Pervasive Development Disorder.
ARTICLE 16B. WEST VIRGINIA CHILDREN'S HEALTH INSURANCE PROGRAM.
§5-16B-6e. Required coverage for autism spectrum disorder.
(a) Every policy of insurance or insurance plan provided in
the provisions of this article which provides coverage for
hospital, surgical, or medical care coverage in the State of West
Virginia shall include full coverage for early detection, diagnosis
and treatment of autism spectrum disorder, including all
prevention, early detection, diagnosis and/or treatments and
therapies that are approved by the Federal Drug Administration and
shall meet the following requirements:
(1) Every policy must provide full in-state or in-network
coverage for early detection, diagnosis and treatment of autism
spectrum disorder notwithstanding that the insured is unable to
receive a service, or treatment from an out-of-state provider.
(2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six years of
age.
(3) Coverage for behavioral therapy may not exceed a $50,000
maximum benefit per child per year.
(4) Coverage shall be provided for up to four visits, or
consultations, with a certified nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for
autism spectrum disorder will be covered by the policy when
prescribed by a treating physician or health care provider.
(6) All prescription medications for autism spectrum disorder
shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(8) Coverage for all medical testing performed on an
individual diagnosed with autism spectrum disorder will be provided
in full when recommended, or prescribed, by a treating physician or
health care provider.
(9) No visitation limits will be imposed for occupational,
physical and speech therapy.
(10) No visitation limits will be imposed for appointments
with a treating physician or health care provider.
(b) For purposes of this section, "autism spectrum disorder"
means one or more or a combination of the following neurobiological
conditions: Autism, Asperger Syndrome, Retts Syndrome, or Pervasive Development Disorder.
CHAPTER 33.
INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-22. Required policy coverage for autism spectrum disorder.
(a) Every policy of insurance or insurance plan provided in
the provisions of this article which provides coverage for
hospital, surgical, or medical care coverage in the State of West
Virginia shall include full coverage for early detection, diagnosis
and treatment of autism spectrum disorder, including all
prevention, early detection, diagnosis and/or treatments and
therapies that are approved by the Federal Drug Administration and
shall meet the following requirements:
(1) Every policy must provide full in-state or in-network
coverage for early detection, diagnosis and treatment of autism
spectrum disorder notwithstanding that the insured is unable to
receive a service, or treatment from an out-of-state provider.
(2) The benefits and coverage must be provided to any person
diagnosed with autism spectrum disorder under twenty-six years of
age.
(3) Coverage for behavioral therapy may not exceed a $50,000
maximum benefit per child per year.
(4) Coverage shall be provided for up to four visits, or
consultations, with a certified nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when
prescribed by a treating physician or health care provider.
(6) All prescription medications for autism spectrum disorder
shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(8) Coverage for all medical testing performed on an
individual diagnosed with autism spectrum disorder will be provided
in full when recommended, or prescribed, by a treating physician or
health care provider.
(9) No visitation limits will be imposed for occupational,
physical and speech therapy.
(10) No visitation limits will be imposed for appointments
with a treating physician or health care provider.
(b) For purposes of this section, "autism spectrum disorder"
means one or more or a combination of the following neurobiological
conditions: Autism, Asperger Syndrome, Retts Syndrome, or
Pervasive Development Disorder.
(c) Notwithstanding any provision of this code to the
contrary, this section, together with section seven-f, article
sixteen, chapter five of this code, section six-e, article sixteen,
chapter five of this code, section eighteen, article sixteen,
chapter thirty-three and section seventeen, article sixteen,
chapter thirty-three of this code is known as and may be collectively cited as "Cameron and Dominic's Law".
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-18.
Required policy coverage for autism spectrum disorder.
(a) Every policy of insurance or insurance plan provided in
the provisions of this article which provides coverage for
hospital, surgical, or medical care coverage in the State of West
Virginia shall include full coverage for early detection, diagnosis
and treatment of autism spectrum disorder, including all
prevention, early detection, diagnosis and/or treatments and
therapies that are approved by the Federal Drug Administration and
shall meet the following requirements:
(1) Every policy must provide full in-state or in-network
coverage for early detection, diagnosis and treatment of autism
spectrum disorder notwithstanding that the insured is unable to
receive a service, or treatment from an out-of-state provider.
(2) The benefits and coverage must be provided to any person
diagnosed with autism spectrum disorder under twenty-six years of
age.
(3) Coverage for behavioral therapy may not exceed a $50,000
maximum benefit per child per year.
(4) Coverage shall be provided for up to four visits, or
consultations, with a certified nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for
autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider.
(6) All prescription medications for autism spectrum disorder
shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(8) Coverage for all medical testing performed on an
individual diagnosed with autism spectrum disorder will be provided
in full when recommended, or prescribed, by a treating physician or
health care provider.
(9) No visitation limits will be imposed for occupational,
physical and speech therapy.
(10) No visitation limits will be imposed for appointments
with a treating physician or health care provider.
(b) For purposes of this section, "autism spectrum disorder"
means one or more or a combination of the following neurobiological
conditions: Autism, Asperger Syndrome, Retts Syndrome, or
Pervasive Development Disorder.
ARTICLE 16D. MARKETING AND RATE PRACTICES FOR SMALL EMPLOYER
ACCIDENT AND SICKNESS INSURANCE POLICIES.
§33-16D-17.
Required policy coverage for autism spectrum
disorder.
(a) Every policy of insurance or insurance plan provided in
the provisions of this article which provides coverage for
hospital, surgical, or medical care coverage in the State of West Virginia shall include full coverage for early detection, diagnosis
and treatment of autism spectrum disorder, including all
prevention, early detection, diagnosis and/or treatments and
therapies that are approved by the Federal Drug Administration and
shall meet the following requirements:
(1) Every policy must provide full in-state or in-network
coverage for early detection, diagnosis and treatment of autism
spectrum disorder notwithstanding that the insured is unable to
receive a service, or treatment from an out-of-state provider.
(2) The benefits and coverage must be provided to any person
diagnosed with autism spectrum disorder under twenty-six years of
age.
(3) Coverage for behavioral therapy may not exceed a $50,000
maximum benefit per child per year.
(4) Coverage shall be provided for up to four visits, or
consultations, with a certified nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for
autism spectrum disorder will be covered by the policy when
prescribed by a treating physician or health care provider.
(6) All prescription medications for autism spectrum disorder
shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination
for early detection and diagnosis of autism spectrum disorder.
(8) Coverage for all medical testing performed on an individual diagnosed with autism spectrum disorder will be provided
in full when recommended, or prescribed, by a treating physician or
health care provider.
(9) No visitation limits will be imposed for occupational,
physical and speech therapy.
(10) No visitation limits will be imposed for appointments
with a treating physician or health care provider.
(b) For purposes of this section, "autism spectrum disorder"
means one or more or a combination of the following neurobiological
conditions: Autism, Asperger Syndrome, Retts Syndrome, or
Pervasive Development Disorder.
NOTE: The purpose of this bill is to provide insurance for the
detection and treatment of autism.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.