The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 756
INTRODUCER: Banking and Insurance Committee and Senator Burton
SUBJECT: Health Insurance Coverage for Individuals with Developmental Disabilities
DATE: April 1, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Johnson Knudson BI Fav/CS
2. Barr McKnight AHS Favorable
3. Johnson Siples FP Pre-meeting
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 756 revises eligibility provisions relating to coverage of autism spectrum disorder (ASD),
thereby expanding coverage and access to coverage in the large group market (coverage through
an employer with more than 50 employees). Autism spectrum disorder (ASD) is a neurological
and developmental disorder that affects how individuals interact with others, communicate,
learn, and behave. Although ASD can be diagnosed at any age, it is described as a
“developmental disorder” because symptoms generally appear in the first two years of life.
1
The bill revises the definition of the term, “autism spectrum disorder,” to conform with the
definition provided in the most recent edition of the Diagnostic and Statistical Manual of Mental
Disorders.
2
The bill also eliminates the age eligibility limitations on providing large group insurance
coverage for ASD, thereby expanding eligibility for coverage to all individuals with ASD. ,
rather than just individuals with ASD who are under 18 years of age and individuals with ASD in
high school at age 18 or older who were diagnosed with a developmental disability before age 9.
1
National Institute of Health, Autism Spectrum Disorder (Dec. 2024), https://www.nimh.nih.gov/health/topics/autism-
spectrum-disorders-asd (last visited Mar. 1, 2025).
2
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR (Mar. 2022). The
DSM is standard classification of mental disorders used by mental health professionals in the United States to diagnose
mental disorders.
REVISED: BILL: CS/SB 756 Page 2
The bill may have an indeterminate impact on the state group health insurance program. See
Section V. Fiscal Impact Statement.
The bill takes effect January 1, 2026.
II. Present Situation:
Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how
individuals interact with others, communicate, learn, and behave. Although ASD can be
diagnosed at any age, it is described as a “developmental disorder” because symptoms generally
appear in the first two years of life.
3
About 1 in 36 children have been identified with ASD.
4
ASD is nearly 4 times more common among boys than among girls.
5
Diagnosis of Autism Spectrum Disorder
Diagnosing ASD usually relies on parents’ or caregivers’ descriptions of their child’s
development and a licensed professional’s observation of the child’s behavior. The American
Psychiatric Association's Diagnostic and Statistical Manual (DSM-5-TR), provides standardized
criteria to help diagnose ASD.
6
The term, “autism spectrum disorder”, reflects a scientific consensus that four previously
separate disorders are a single condition with different levels of symptom severity in two core
domains.
7
ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s
disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise
specified.
8
ASD is characterized by (1) deficits in social communication and social interaction
and (2) restricted repetitive behaviors, interests, and activities (RRBs). Because both components
are required for diagnosis of ASD, social communication disorder is diagnosed if no RRBs are
present.
To meet diagnostic criteria for ASD pursuant to DSM-5-TR, a child must have persistent deficits
in each of three areas of social communication and interaction (see A.1. through A.3. below) plus
at least two of four types of restricted, repetitive behaviors (see B.1. through B.4. below):
3
National Institute of Health, Autism Spectrum Disorder (Dec. 2024), https://www.nimh.nih.gov/health/topics/autism-
spectrum-disorders-asd (last visited Mar. 1, 2025).
4
Centers for Disease Control, Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years
— Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020 | MMWR (Mar. 24, 2023),
(last visited Feb. 28, 2025).
5
Id.
6
American Psychiatric Association, Frequently Asked Questions,
https://www.psychiatry.org/psychiatrists/practice/dsm/frequently-asked-
questions#:~:text=What%20is%20DSM%20and%20why,the%20diagnosis%20of%20mental%20disorders (last visited Feb.
28, 2025).
7
American Psychiatric Association, Highlights of Changes from DSM-IV-TR to DSM-5 (2022)
APA_DSM_Changes_from_DSM-IV-TR_-to_DSM-5.pdf. (last visited Mar. 1, 2025).
8
Id. BILL: CS/SB 756 Page 3
A. Persistent deficits in social communication and social interaction across multiple contexts, as
manifested by all the following, currently or by history (examples are illustrative, not
exhaustive):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social
approach and failure of normal back-and-forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities
in eye contact and body language or deficits in understanding and use of gestures; to a
total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for
example, from difficulties adjusting behavior to suit various social contexts; to
difficulties in sharing imaginative play or in making friends; to absence of interest in
peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least
two of the following, currently or by history (examples are illustrative, not exhaustive; see
text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal
or nonverbal behavior (e.g., extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same
food every day). Highly restricted, fixated interests that are abnormal in intensity or focus
(e.g., strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong
attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverative interests).
4. Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects
of the environment (e.g., apparent indifference to pain/temperature, adverse response to
specific sounds or textures, excessive smelling or touching of objects, visual fascination
with lights or movement).
9
Treatment and Intervention for ASD
10
Current treatments for ASD seek to reduce symptoms that interfere with daily functioning and
quality of life. Treatments can be given in education, health, community, or home settings, or a
combination of settings. As individuals with ASD leave high school and grow into adulthood,
additional services can help improve health and daily functioning and facilitate social and
community engagement.
9
See Centers for Disease Control, Autism Spectrum Disorder, Clinical Testing and Diagnosis for Autism Spectrum Disorder,
Clinical Testing and Diagnosis for Autism Spectrum Disorder | Autism Spectrum Disorder (ASD) | CDC (last visited Feb. 28,
2025). Additional diagnostic criteria for ASD is described.
10
Centers for Disease Control, Treatment and Intervention for Autism Spectrum Disorder (May 16, 2024), Treatment and
Intervention for Autism Spectrum Disorder | Autism Spectrum Disorder (ASD) | CDC (last visited Mar. 1, 2025). BILL: CS/SB 756 Page 4
There are many types of treatments available. These treatments generally can be broken down
into the following categories, although some treatments involve more than one approach:
• Behavioral
• Educational.
• Social-relational.
• Pharmacological.
• Psychological.
• Complementary and alternative.
Requirements Related to the Federal Mental Health Parity and Addiction Equity Act
11
On December 23, 2024, final rules for amending regulations implementing the Paul Wellstone
and Pete Domenici Mental Parity and Addiction Equity Act of 2008 (MHPAEA) were released.
12
These final rules aim to further MHPAEA’s fundamental purpose to ensure that individuals with
group health plans or group or individual health insurance coverage who seek treatment for
covered mental health (MH) conditions or substance use disorders (SUDs) do not face greater
burdens on access to benefits for those conditions or disorders than they would face when
seeking coverage for the treatment of a medical condition or a surgical procedure. Specifically,
these final rules amend the existing non-quantitative treatment limitations (NQTL) standard to
prohibit group health plans and health insurance issuers offering group or individual health
insurance coverage from using NQTLs that place greater restrictions on access to mental health
and substance use disorder benefits as compared to medical/surgical benefits.
The Employee Benefits Security Administration and the Centers for Medicare and Medicaid are
responsible for enforcing MHPAEA, together with states that have the authority to enforce
MHPAEA.
13
Florida has not enacted legislation that authorizes the Office of Insurance
Regulation to enforce the provisions of MHPAEA. Although the law requires a general
equivalence in the way MH/SUD and medical/surgical benefits are treated with respect to annual
and lifetime dollar limits, financial requirements and treatment limitations, MHPAEA does not
require group health plans or health insurers to cover MH/SUD benefits. However, the Patient
Protection and Affordable Care Act
14
builds on MHPAEA and requires coverage of mental
11
Centers for Medicare and Medicaid Services, https://www.cms.gov/marketplace/private-health-insurance/mental-health-
parity-addiction-equity (last visited Mar. 7, 2025).
12
See Public Law 116-260 and 45 C.F.R. Parts 146 and 147.
13
U.S. Department of Labor, FY 2022 MHPAEA Enforcement Fact Sheet, https://www.dol.gov/agencies/ebsa/laws-and-
regulations/laws/mental-health-parity/mhpaea-enforcement-
2022#:~:text=These%20protections%20are%20vital%20for,MHPAEA%2C%20together%20with%20the%20states. (last
visited Mar. 7, 2025).
14
P.L. 111-148, 124 Stat. 119-1945 (2010). PPACA was amended by P.L. 111-152, the Health Care and Education
Reconciliation Act of 2010. BILL: CS/SB 756 Page 5
health and substance use disorder services as one of ten essential health benefits categories in
non-grandfathered individual and small group plans.
State Regulation of Insurance in Florida
The Office of Insurance Regulation (OIR),
15
is responsible for all activities concerning health
maintenance organizations (HMOs), health insurers and other risk-bearing entities, including
licensing, rates, policy forms, market conduct, claims, issuance of certificates of authority,
solvency, viatical settlements, premium financing, and administrative supervision, as provided
under the Florida Insurance Code.
16
To transact business in Florida, a health insurer or HMO
must obtain a certificate of authority from the OIR.
17
The Agency for Health Administration
(Agency) regulates the quality of care provided by HMOs under part III of ch. 641, F.S. Prior to
receiving a certificate of authority from the OIR, an HMO must receive a Health Care Provider
Certificate from the Agency.
18
As part of the certification process used by the Agency, an HMO
must provide information to demonstrate that the HMO has the ability to provide quality of care
consistent with the prevailing standards of care.
19
Coverage for Autism Spectrum Disorder in Florida
The Florida Insurance Code provides coverage for autism spectrum disorder for the insureds or
members in the large group market,
20
including the state group insurance plan,
21
for eligible
individuals.
22
Under current statute, “autism spectrum disorder”
23
is any of the following
disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental
Disorders of the American Psychiatric Association:
• Autistic disorder;
• Asperger’s syndrome; and
• Pervasive developmental disorder not otherwise specified.
“An eligible individual” means an individual under 18 years of age or an individual 18 years of
age or older who is in high school who has been diagnosed as having a developmental disability
at 8 years of age or younger.
24
Such coverage must include, at a minimum, the following benefits:
25
• Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder.
15
The OIR is a unit under the Financial Services Commission, which is composed of the Governor, the Attorney General, the
Chief Financial Officer, and the Commissioner of Agriculture. Commission members serve as the agency head for purposes
of rulemaking under ch. 120, F.S. See s. 20.121(3), F.S.
16
Section 20.121(3)(a), F.S.
17
Sections 624.401 and 641.49, F.S.
18
Section 641.495, F.S.
19
Id.
20
A large group plan provides coverage for an employer with more than 50 employees.
21
Section 110.123, F.S.
22
Section 627.6686, F.S. applies to insurers and s. 641.31098, F.S., applies to health maintenance organizations.
23
Sections 627.6686(2)(b), F.S., and 641.31098(2)(b), F.S.
24
Sections 627.6686(2)(c), and 641.31098(2)(c), F.S.
25
Sections 627.6686(3) and 641.31098(3), F.S. BILL: CS/SB 756 Page 6
• Treatment of autism spectrum disorder and Down syndrome through speech therapy,
occupational therapy, physical therapy, and applied behavior analysis. Applied behavior
analysis services shall be provided by an individual certified pursuant to s. 393.17,
26
F.S., or
an individual licensed under ch. 490
27
or ch. 491.
28
The coverage mandated under this section is subject to the following requirements:
29
• Coverage shall be limited to treatment that is prescribed by the insured’s treating physician in
accordance with a treatment plan.
• Such coverage is limited to $36,000 annually and may not exceed $200,000 in total lifetime
benefits. The maximum benefits must be adjusted annually on January 1 of each calendar
year to reflect any change from the previous year in the medical component of the then
current Consumer Price Index for All Urban Consumers, published by the Bureau of Labor
Statistics of the United States Department of Labor
• Coverage may not be denied on the basis that provided services are habilitative in nature.
• Coverage may be subject to other general exclusions and limitations of the insurer’s policy or
plan, including, but not limited to, coordination of benefits, participating provider
requirements, restrictions on services provided by family or household members, and
utilization review of health care services, including the review of medical necessity, case
management, and other managed care provisions.
Coverage for Mental and Nervous Disorders
Section 627.668, F.S., requires insurers and health maintenance organization group health plans
to make available to the policyholder (i.e. employer) as part of the application, for an appropriate
additional premium, under a hospital and medical expense-incurred insurance policy, under a
prepaid health care contract, and under a hospital and medical service plan contract, coverage for
mental and nervous disorders. Under group policies or contracts, inpatient hospital benefits,
partial hospitalization benefits, and outpatient benefits consisting of durational limits, dollar
amounts, deductibles, and coinsurance factors shall not be less favorable than for physical illness
generally, except that:
• Inpatient benefits may be limited to not less than 30 days per benefit year as defined in the
policy or contract. If inpatient hospital benefits are provided beyond 30 days per benefit year,
the durational limits, dollar amounts, and coinsurance factors thereto need not be the same as
applicable to physical illness generally.
• Outpatient benefits may be limited to $1,000 for consultations with a licensed physician, a
psychologist licensed pursuant to ch. 490, F.S., a mental health counselor licensed pursuant
to ch. 491, F.S., a marriage and family therapist licensed pursuant to ch 491, F.S., and a
clinical social worker licensed pursuant to ch 491, F.S. If benefits are provided beyond the
$1,000 per benefit year, the durational limits, dollar amounts, and coinsurance factors thereof
need not be the same as applicable to physical illness generally.
26
Behavior analysts.
27
Practice of psychology.
28
The scope of this chapter includes the practice of clinical social work, practice of marriage and family therapy, practice of
mental health counseling.
29
Sections 627.6686(4) and 641.31098(4), F.S. BILL: CS/SB 756 Page 7
• Partial hospitalization benefits shall be provided under the direction of a licensed physician.
For purposes of this part, the term “partial hospitalization services” is defined as those
services offered by a program that is accredited by an accrediting organization whose
standards incorporate comparable regulations required by this state. Alcohol rehabilitation
programs accredited by an accrediting organization whose standards incorporate comparable
regulations required by this state or approved by the state and licensed drug abuse
rehabilitation programs shall also be qualified providers under this section. In a given benefit
year, if partial hospitalization services or a combination of inpatient and partial
hospitalization are used, the total benefits paid for all such services may not exceed the cost
of 30 days after inpatient hospitalization for psychiatric services, including physician fees,
which prevail in the community in which the partial hospitalization services are rendered. If
partial hospitalization services benefits are provided beyond the limits set forth in this
paragraph, the durational limits, dollar amounts, and coinsurance factors thereof need not be
the same as those applicable to physical illness generally.
III. Effect of Proposed Changes:
Sections 1 and 2 amend ss. 627.6696 and 641.31098, F.S., relating to health insurance and
health maintenance organization coverage of autism spectrum disorders (ASD) in the large group
market, respectively.
The sections revise the definition of ASD to mean as defined in the most recent edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric
Association and removes from statute the enumerate disorders that have been incorporated into
the new DSM definition. Under current law, ASD is defined to mean any of the following
disorders as defined by the DSM of the American Psychiatric Association:
• Autistic disorder.
• Asperger’s syndrome.
• Pervasive developmental disorder not otherwise specified.
The term “eligible individual,” as it applies to ASD coverage, is revised to eliminate the general
age cap of age 18 for coverage and the associated age cap for diagnosis. Under current law, an
eligible individual must be under age 18 or be an individual 18 years of age or older who is in
high school who has been diagnosed with a developmental disability at 8 years of age or
younger.
Sections 3 and 4 reenact ss. 409.906(26) and 943.1727, F.S., to incorporate the bill’s
amendments to s. 627.6686, F.S.
Section 5 provides the bill takes effect January 1, 2026.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None. BILL: CS/SB 756 Page 8
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
Since the bill removes the current age limit and diagnosis restriction by age 8 for
coverage of an individual in the large group market who has been diagnosed with a
developmental disorder, additional individuals diagnosed with autism spectrum disorder
will be eligible for coverage, and existing insureds or members can continue coverage
beyond age 18.
C. Government Sector Impact:
The Office of Insurance Regulation and the Agency for Health Care Administration
report no immediate impacts to state revenues or expenditures.
30,31
However, increased
utilization of services due to changes in eligibility criteria for autism spectrum disorder
could have an indeterminate impact on future capitation rates under the Florida Medicaid
Program. The Department of Management Services estimates that the fiscal impact of the
bill, as it relates to the State Group Insurance Program, is less than $650,000 across all
plans.
32
VI. Technical Deficiencies:
None.
30
Office of Insurance Regulation, Senate Bill 756 Analysis (Feb. 24, 2025) (on file with the Senate Appropriations
Committee on Health and Human Services).
31
Agency for Health Care Administration, Senate Bill 756 Analysis (Feb. 25, 2025) (on file with the Senate Appropriations
Committee on Health and Human Services).
32
Department of Management Services, Senate Bill 756 Agency Analysis (Mar. 10, 2025) (on file with the Senate
Appropriations Committee on Health and Human Services). BILL: CS/SB 756 Page 9
VII. Related Issues:
The heading or catchline for s. 627.6696, F.S., is “Coverage for individuals with autism spectrum
disorder required; exceptions.” However, the section relates to coverage for a broader group of
individuals. Therefore, the catchline could be amended to “Coverage for individuals with
developmental disorders; exceptions.”
VIII. Statutes Affected
This bill substantially amends the following sections of statute: 627.6686 and 641.31098.
This bill reenacts the following sections of statute: 409.906 and 943.1727.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Banking and Insurance on March 7, 2026:
The CS changes the effective date of the bill from July 1, 2025, to January 1, 2026.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.