Bill Summaries: H646 (2015-2016 Session)

Tracking:
  • Summary date: Apr 13 2015 - View summary

    Enacts new GS 58-3-192, requiringhealth benefit plans to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. Prohibits an insurer from terminating coverage or refusing to issue, amend, or renew coverage to an individual solely because the individual is diagnosed with autism spectrum disorder or has received treatment for autism spectrum disorder. Prohibitslimiting the number of visits an individual may have for treatment of autism spectrum disorder, except provides that coverage for habilitative services may be limited to children age 18 or younger and may be subject to a maximum benefit of 40 hours per week.

    Provides definitions for terms as they apply in this statute.

    Prohibits denying coverage under this section on the basis that the treatments are habilitative or educational in nature.

    Provides that coveragemay be subject to co-payment, deductible, and coinsurance provisions of a health benefit plan that are not less favorable than the co-payment, deductible, and coinsurance provisions that apply to substantially all medical services covered by the health benefit plan.

    Prohibits construing this section as (1) limiting benefits otherwise available to an individual under a health benefit plan or (2) affecting any obligation to provide services to an individual under an individualized family service plan, education program, or service plan.

    Enacts new GS 58-3-193 to definehabilitative services to mean health care services that help a person keep, learn, or improve skills and functioning for daily living. Provides that habilitative services include, but are not limited to: (1) physical and occupational therapy, (2) speech-language therapy, (3) speech/swallowing therapy, (4) applied behavior analysis, (5) medical equipment, and (6) orthotics and prosthetics.

    Applies to insurance contracts issued, renewed, or amended on or after October 1, 2015.