Connecticut 2024 Regular Session

Connecticut Senate Bill SB00320 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 1559 1 of 10
4	4
5	5	General Assembly Raised Bill No. 320
6	6	February Session, 2024
7	7	LCO No. 1559
8	8
9	9
10	10	Referred to Committee on INSURANCE AND REAL ESTATE
11	11
12	12
13	13	Introduced by:
14	14	(INS)
15	15
16	16
17	17
18	18
19	19	AN ACT CONCERNING EARLY CHILDHOOD DEVELOPMENTAL
20	20	DISORDERS.
21	21	Be it enacted by the Senate and House of Representatives in General
22	22	Assembly convened:
23	23
24	24	Section 1. Section 38a-488b of the 2024 supplement to the general 1
25	25	statutes is repealed and the following is substituted in lieu thereof 2
26	26	(Effective January 1, 2025): 3
27	27	(a) As used in this section: 4
28	28	(1) "Applied behavior analysis" means the design, implementation 5
29	29	and evaluation of environmental modifications, using behavioral 6
30	30	stimuli and consequences, including the use of direct observation, 7
31	31	measurement and functional analysis of the relationship between 8
32	32	environment and behavior, to produce socially significant improvement 9
33	33	in human behavior. 10
34	34	[(2) "Autism spectrum disorder services provider" means any person, 11
35	35	entity or group that provides treatment for an autism spectrum disorder 12
36	36	pursuant to this section.] 13 Raised Bill No. 320
37	37
38	38
39	39
40	40	LCO No. 1559 2 of 10
41	41
42	42	[(3)] (2) ["Autism spectrum disorder"] "Autism spectrum disorders" 14
43	43	means ["autism spectrum disorder"] one or more pervasive 15
44	44	developmental disorders as set forth in the most recent edition of the 16
45	45	American Psychiatric Association's "Diagnostic and Statistical Manual 17
46	46	of Mental Disorders" or the most recent edition of the International 18
47	47	Classification of Diseases. 19
48	48	[(4)] (3) "Behavioral therapy" means any interactive behavioral 20
49	49	therapies derived from evidence-based research, [and consistent with 21
50	50	the services and interventions designated by the Commissioner of Social 22
51	51	Services pursuant to subsection (e) of section 17a-215c,] including, but 23
52	52	not limited to, applied behavior analysis, cognitive behavioral therapy 24
53	53	[,] or other therapies supported by empirical evidence of the effective 25
54	54	treatment of individuals diagnosed with [autism spectrum disorder] an 26
55	55	early childhood developmental disorder, that are: (A) Provided to 27
56	56	children less than twenty-one years of age; and (B) provided or 28
57	57	supervised by (i) a licensed behavior analyst, (ii) a licensed physician, 29
58	58	or (iii) a licensed psychologist. For the purposes of this subdivision, 30
59	59	behavioral therapy is "supervised by" such licensed behavior analyst, 31
60	60	licensed physician or licensed psychologist when such supervision 32
61	61	entails at least one hour of face-to-face supervision of the [autism 33
62	62	spectrum disorder] early childhood developmental disorder services 34
63	63	provider by such licensed behavior analyst, licensed physician or 35
64	64	licensed psychologist for each ten hours of behavioral therapy provided 36
65	65	by the supervised provider. 37
66	66	[(5)] (4) ["Diagnosis"] "Diagnosis of early childhood developmental 38
67	67	disorders" means the medically necessary assessment, evaluation or 39
68	68	testing performed by a licensed physician, licensed psychologist or 40
69	69	licensed clinical social worker to determine if an individual has an early 41
70	70	childhood developmental delay, including, but not limited to, any 42
71	71	autism spectrum [disorder] disorders. 43
72	72	(5) "Early childhood developmental disorder" means a childhood 44
73	73	mental or physical impairment or combination of such mental or 45
74	74	physical impairments, including, but not limited to, autism spectrum 46 Raised Bill No. 320
75	75
76	76
77	77
78	78	LCO No. 1559 3 of 10
79	79
80	80	disorders, that results in functional limitations in major life activities. 47
81	81	"Early childhood developmental disorder" does not include a learning 48
82	82	disability, as defined in section 46a-51. 49
83	83	(6) "Early childhood developmental disorder services provider" 50
84	84	means any person, entity or group that provides treatment for an early 51
85	85	childhood developmental disorder pursuant to this section. 52
86	86	(b) Each individual health insurance policy providing coverage of the 53
87	87	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 54
88	88	that is delivered, issued for delivery, renewed, amended or continued 55
89	89	in this state on or after January 1, 2025, shall provide coverage for the 56
90	90	diagnosis and treatment of [autism spectrum disorder] any early 57
91	91	childhood developmental disorder. For the purposes of this section and 58
92	92	section 38a-482a, [autism spectrum disorder] an early childhood 59
93	93	developmental disorder shall be considered an illness. 60
94	94	(c) Such policy shall provide coverage for the following treatments, 61
95	95	provided such treatments are (1) medically necessary, and (2) identified 62
96	96	and ordered by a licensed physician, licensed psychologist or licensed 63
97	97	clinical social worker for an insured who is diagnosed with [autism 64
98	98	spectrum disorder] any early childhood developmental disorder, in 65
99	99	accordance with a treatment plan developed by a licensed behavior 66
100	100	analyst, licensed physician, licensed psychologist or licensed clinical 67
101	101	social worker, pursuant to a comprehensive evaluation or reevaluation 68
102	102	of the insured: 69
103	103	(A) Behavioral therapy; 70
104	104	(B) Prescription drugs, to the extent prescription drugs are a covered 71
105	105	benefit for other diseases and conditions under such policy, prescribed 72
106	106	by a licensed physician, a licensed physician assistant or an advanced 73
107	107	practice registered nurse for the treatment of symptoms and 74
108	108	comorbidities of [autism spectrum disorder] such early childhood 75
109	109	developmental disorder; 76
110	110	(C) Direct psychiatric or consultative services provided by a licensed 77 Raised Bill No. 320
111	111
112	112
113	113
114	114	LCO No. 1559 4 of 10
115	115
116	116	psychiatrist; 78
117	117	(D) Direct psychological or consultative services provided by a 79
118	118	licensed psychologist; 80
119	119	(E) Physical therapy provided by a licensed physical therapist; 81
120	120	(F) Speech and language pathology services provided by a licensed 82
121	121	speech and language pathologist; and 83
122	122	(G) Occupational therapy provided by a licensed occupational 84
123	123	therapist. 85
124	124	(d) Such policy shall not impose (1) any limits on the number of visits 86
125	125	an insured may make to an [autism spectrum disorder] early childhood 87
126	126	developmental disorder services provider pursuant to a treatment plan 88
127	127	on any basis other than a lack of medical necessity, or (2) a coinsurance, 89
128	128	copayment, deductible or other out-of-pocket expense for such coverage 90
129	129	that places a greater financial burden on an insured for access to the 91
130	130	diagnosis and treatment of [autism spectrum disorder] such early 92
131	131	childhood developmental disorder than for the diagnosis and treatment 93
132	132	of any other medical, surgical or physical health condition under such 94
133	133	policy. 95
134	134	(e) (1) Except for treatments and services received by an insured in an 96
135	135	inpatient setting, an insurer, health care center, hospital service 97
136	136	corporation, medical service corporation or fraternal benefit society may 98
137	137	review a treatment plan developed as set forth in subsection (c) of this 99
138	138	section for such insured, in accordance with its utilization review 100
139	139	requirements, not more than once every six months unless such 101
140	140	insured's licensed physician, licensed psychologist or licensed clinical 102
141	141	social worker agrees that a more frequent review is necessary or changes 103
142	142	such insured's treatment plan. 104
143	143	(2) For the purposes of this section, the results of a diagnosis shall be 105
144	144	valid for a period of not less than twelve months, unless such insured's 106
145	145	licensed physician, licensed psychologist or licensed clinical social 107 Raised Bill No. 320
146	146
147	147
148	148
149	149	LCO No. 1559 5 of 10
150	150
151	151	worker determines a shorter period is appropriate or changes the results 108
152	152	of such insured's diagnosis. 109
153	153	(f) Coverage required under this section may be subject to the other 110
154	154	general exclusions and limitations of the individual health insurance 111
155	155	policy, including, but not limited to, coordination of benefits, 112
156	156	participating provider requirements, restrictions on services provided 113
157	157	by family or household members and case management provisions, 114
158	158	except that any utilization review shall be performed in accordance with 115
159	159	subsection (e) of this section. 116
160	160	(g) (1) Nothing in this section shall be construed to limit or affect (A) 117
161	161	any other covered benefits available to an insured under (i) such 118
162	162	individual health insurance policy, (ii) section 38a-488a, or (iii) section 119
163	163	38a-490a, (B) any obligation to provide services to an individual under 120
164	164	an individualized education program pursuant to section 10-76d, or (C) 121
165	165	any obligation imposed on a public school by the Individual With 122
166	166	Disabilities Education Act, 20 USC 1400 et seq., as amended from time 123
167	167	to time. 124
168	168	(2) Nothing in this section shall be construed to require such 125
169	169	individual health insurance policy to provide reimbursement for special 126
170	170	education and related services provided to an insured pursuant to 127
171	171	section 10-76d, unless otherwise required by state or federal law. 128
172	172	Sec. 2. Section 38a-514b of the 2024 supplement to the general statutes 129
173	173	is repealed and the following is substituted in lieu thereof (Effective 130
174	174	January 1, 2025): 131
175	175	(a) As used in this section: 132
176	176	(1) "Applied behavior analysis" means the design, implementation 133
177	177	and evaluation of environmental modifications, using behavioral 134
178	178	stimuli and consequences, including the use of direct observation, 135
179	179	measurement and functional analysis of the relationship between 136
180	180	environment and behavior, to produce socially significant improvement 137
181	181	in human behavior. 138 Raised Bill No. 320
182	182
183	183
184	184
185	185	LCO No. 1559 6 of 10
186	186
187	187	[(2) "Autism spectrum disorder services provider" means any person, 139
188	188	entity or group that provides treatment for autism spectrum disorder 140
189	189	pursuant to this section.] 141
190	190	[(3)] (2) ["Autism spectrum disorder"] "Autism spectrum disorders" 142
191	191	means ["autism spectrum disorder"] one or more pervasive 143
192	192	developmental disorders as set forth in the most recent edition of the 144
193	193	American Psychiatric Association's "Diagnostic and Statistical Manual 145
194	194	of Mental Disorders" or the most recent edition of the International 146
195	195	Classification of Diseases. 147
196	196	[(4)] (3) "Behavioral therapy" means any interactive behavioral 148
197	197	therapies derived from evidence-based research, [and consistent with 149
198	198	the services and interventions designated by the Commissioner of Social 150
199	199	Services pursuant to subsection (e) of section 17a-215c,] including, but 151
200	200	not limited to, applied behavior analysis, cognitive behavioral therapy 152
201	201	[,] or other therapies supported by empirical evidence of the effective 153
202	202	treatment of individuals diagnosed with [autism spectrum disorder] an 154
203	203	early childhood developmental disorder, that are: (A) Provided to 155
204	204	children less than twenty-one years of age; and (B) provided or 156
205	205	supervised by (i) a licensed behavior analyst, (ii) a licensed physician, 157
206	206	or (iii) a licensed psychologist. For the purposes of this subdivision, 158
207	207	behavioral therapy is "supervised by" such licensed behavior analyst, 159
208	208	licensed physician or licensed psychologist when such supervision 160
209	209	entails at least one hour of face-to-face supervision of the [autism 161
210	210	spectrum disorder] early childhood developmental disorder services 162
211	211	provider by such licensed behavior analyst, licensed physician or 163
212	212	licensed psychologist for each ten hours of behavioral therapy provided 164
213	213	by the supervised provider. 165
214	214	[(5)] (4) ["Diagnosis"] "Diagnosis of early childhood developmental 166
215	215	disorders" means the medically necessary assessment, evaluation or 167
216	216	testing performed by a licensed physician, licensed psychologist or 168
217	217	licensed clinical social worker to determine if an individual has an early 169
218	218	childhood developmental delay, including, but not limited to, any 170
219	219	autism spectrum [disorder] disorders. 171 Raised Bill No. 320
220	220
221	221
222	222
223	223	LCO No. 1559 7 of 10
224	224
225	225	(5) "Early childhood developmental disorder" means a childhood 172
226	226	mental or physical impairment or combination of such mental or 173
227	227	physical impairments, including, but not limited to, autism spectrum 174
228	228	disorders, that results in functional limitations in major life activities. 175
229	229	"Early childhood developmental disorder" does not include a learning 176
230	230	disability, as defined in section 46a-51. 177
231	231	(6) "Early childhood developmental disorder services provider" 178
232	232	means any person, entity or group that provides treatment for an early 179
233	233	childhood developmental disorder pursuant to this section. 180
234	234	(b) Each group health insurance policy providing coverage of the 181
235	235	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 182
236	236	that is delivered, issued for delivery, renewed, amended or continued 183
237	237	in this state on or after January 1, 2025, shall provide coverage for the 184
238	238	diagnosis and treatment of [autism spectrum disorder] any early 185
239	239	childhood developmental disorder. For the purposes of this section and 186
240	240	section 38a-513c, [autism spectrum disorder] an early childhood 187
241	241	developmental disorder shall be considered an illness. 188
242	242	(c) Such policy shall provide coverage for the following treatments, 189
243	243	provided such treatments are (1) medically necessary, and (2) identified 190
244	244	and ordered by a licensed physician, licensed psychologist or licensed 191
245	245	clinical social worker for an insured who is diagnosed with [autism 192
246	246	spectrum disorder] any early childhood developmental disorder, in 193
247	247	accordance with a treatment plan developed by a licensed behavior 194
248	248	analyst, licensed physician, licensed psychologist or licensed clinical 195
249	249	social worker, pursuant to a comprehensive evaluation or reevaluation 196
250	250	of the insured: 197
251	251	(A) Behavioral therapy; 198
252	252	(B) Prescription drugs, to the extent prescription drugs are a covered 199
253	253	benefit for other diseases and conditions under such policy, prescribed 200
254	254	by a licensed physician, a licensed physician assistant or an advanced 201
255	255	practice registered nurse for the treatment of symptoms and 202
256	256	comorbidities of [autism spectrum disorder] such early childhood 203 Raised Bill No. 320
257	257
258	258
259	259
260	260	LCO No. 1559 8 of 10
261	261
262	262	developmental disorder; 204
263	263	(C) Direct psychiatric or consultative services provided by a licensed 205
264	264	psychiatrist; 206
265	265	(D) Direct psychological or consultative services provided by a 207
266	266	licensed psychologist; 208
267	267	(E) Physical therapy provided by a licensed physical therapist; 209
268	268	(F) Speech and language pathology services provided by a licensed 210
269	269	speech and language pathologist; and 211
270	270	(G) Occupational therapy provided by a licensed occupational 212
271	271	therapist. 213
272	272	(d) Such policy shall not impose (1) any limits on the number of visits 214
273	273	an insured may make to an [autism spectrum disorder] early childhood 215
274	274	developmental disorder services provider pursuant to a treatment plan 216
275	275	on any basis other than a lack of medical necessity, or (2) a coinsurance, 217
276	276	copayment, deductible or other out-of-pocket expense for such coverage 218
277	277	that places a greater financial burden on an insured for access to the 219
278	278	diagnosis and treatment of [autism spectrum disorder] such early 220
279	279	childhood developmental disorder than for the diagnosis and treatment 221
280	280	of any other medical, surgical or physical health condition under such 222
281	281	policy. 223
282	282	(e) (1) Except for treatments and services received by an insured in an 224
283	283	inpatient setting, an insurer, health care center, hospital service 225
284	284	corporation, medical service corporation or fraternal benefit society may 226
285	285	review a treatment plan developed as set forth in subsection (c) of this 227
286	286	section for such insured, in accordance with its utilization review 228
287	287	requirements, not more than once every six months unless such 229
288	288	insured's licensed physician, licensed psychologist or licensed clinical 230
289	289	social worker agrees that a more frequent review is necessary or changes 231
290	290	such insured's treatment plan. 232
291	291	(2) For the purposes of this section, the results of a diagnosis shall be 233 Raised Bill No. 320
292	292
293	293
294	294
295	295	LCO No. 1559 9 of 10
296	296
297	297	valid for a period of not less than twelve months, unless such insured's 234
298	298	licensed physician, licensed psychologist or licensed clinical social 235
299	299	worker determines a shorter period is appropriate or changes the results 236
300	300	of such insured's diagnosis. 237
301	301	(f) Coverage required under this section may be subject to the other 238
302	302	general exclusions and limitations of the group health insurance policy, 239
303	303	including, but not limited to, coordination of benefits, participating 240
304	304	provider requirements, restrictions on services provided by family or 241
305	305	household members and case management provisions, except that any 242
306	306	utilization review shall be performed in accordance with subsection (e) 243
307	307	of this section. 244
308	308	(g) (1) Nothing in this section shall be construed to limit or affect (A) 245
309	309	any other covered benefits available to an insured under (i) such group 246
310	310	health insurance policy, (ii) section 38a-514, or (iii) section 38a-516a, (B) 247
311	311	any obligation to provide services to an individual under an 248
312	312	individualized education program pursuant to section 10-76d, or (C) 249
313	313	any obligation imposed on a public school by the Individual With 250
314	314	Disabilities Education Act, 20 USC 1400 et seq., as amended from time 251
315	315	to time. 252
316	316	(2) Nothing in this section shall be construed to require such group 253
317	317	health insurance policy to provide reimbursement for special education 254
318	318	and related services provided to an insured pursuant to section 10-76d, 255
319	319	unless otherwise required by state or federal law. 256
320	320	This act shall take effect as follows and shall amend the following
321	321	sections:
322	322
323	323	Section 1 January 1, 2025 38a-488b
324	324	Sec. 2 January 1, 2025 38a-514b
325	325
326	326	Statement of Purpose:
327	327	To expand the definition of autism spectrum disorder to include early
328	328	childhood developmental disorders for purposes of health insurance
329	329	coverage. Raised Bill No. 320
330	330
331	331
332	332
333	333	LCO No. 1559 10 of 10
334	334
335	335	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
336	336	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
337	337	underlined.]
338	338