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statutes is repealed and the following is substituted in lieu thereof 2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