KS
Kansas House Bill HB2095

Kansas 2023-2024 Regular Session

Kansas House Bill HB2095 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 Session of 2023
22 HOUSE BILL No. 2095
33 By Committee on Insurance
44 1-19
55 AN ACT concerning insurance; relating to coverage for autism spectrum
66 disorder; changing the required number of employees contained in the
77 definitions of "large employer" and "small employer"; amending
88 K.S.A. 40-2,194 and repealing the existing section.
99 Be it enacted by the Legislature of the State of Kansas:
1010 Section 1. K.S.A. 40-2,194 is hereby amended to read as follows: 40-
1111 2,194. (a) (1) (A) Any large group health insurance policy, medical service
1212 plan, contract, hospital service corporation contract, hospital and medical
1313 service corporation contract, fraternal benefit society or health
1414 maintenance organization which provides coverage for accident and health
1515 services and which is delivered, issued for delivery, amended or renewed
1616 on or after January 1, 2015, shall provide coverage for the diagnosis and
1717 treatment of autism spectrum disorder in any covered individual whose
1818 age is less than 12 years.
1919 (B) Any grandfathered individual or group health insurance policy,
2020 medical service plan, contract, hospital service corporation contract,
2121 hospital and medical service corporation contract, fraternal benefit society
2222 or health maintenance organization which that provides coverage for
2323 accident and health services and which that is delivered, issued for
2424 delivery, amended or renewed on or after January 1, 2016, shall provide
2525 coverage for the diagnosis and treatment of autism spectrum disorder in
2626 any covered individual whose age is less than 12 years.
2727 (2) Such coverage shall be provided in a manner determined in
2828 consultation with the autism services provider and the patient. Services
2929 provided by autism services providers under this section shall include
3030 applied behavior analysis when required by a licensed physician, licensed
3131 psychologist or licensed specialist clinical social worker but otherwise
3232 shall be limited to the care, services and related equipment prescribed or
3333 ordered by a licensed physician, licensed psychologist or licensed
3434 specialist clinical social worker.
3535 (3) Coverage provided under this section for applied behavior
3636 analysis shall be subject to a limitation of:
3737 (A) 1,300 hours per calendar year for four years beginning on the
3838 later of the date of diagnosis or January 1, 2015, for any covered
3939 individual diagnosed with autism spectrum disorder between birth and five
4040 1
4141 2
4242 3
4343 4
4444 5
4545 6
4646 7
4747 8
4848 9
4949 10
5050 11
5151 12
5252 13
5353 14
5454 15
5555 16
5656 17
5757 18
5858 19
5959 20
6060 21
6161 22
6262 23
6363 24
6464 25
6565 26
6666 27
6767 28
6868 29
6969 30
7070 31
7171 32
7272 33
7373 34
7474 35
7575 36 HB 2095 2
7676 years of age; and
7777 (B) except as provided in subparagraph (A), 520 hours per calendar
7878 year for any covered individual less than 12 years of age.
7979 Upon prior approval by the health benefit plan, such maximum benefit
8080 limit may be exceeded if the provision of applied behavior analysis
8181 services beyond the maximum limit is medically necessary for such
8282 individual. Any payment made by an insurer on behalf of a covered
8383 individual for any care, treatment, intervention, service or item, the
8484 provision of which was for the treatment of a health condition unrelated to
8585 such covered individual's autism spectrum disorder, shall not be applied
8686 toward any maximum benefit established under this paragraph. Except for
8787 the coverage for applied behavior analysis, no coverage required under this
8888 section shall be subject to the age and hour limitations described in this
8989 paragraph.
9090 (4) On or after January 1, 2015, through June 30, 2016,
9191 reimbursement shall be allowed only for services provided by a provider
9292 licensed, trained and qualified to provide such services or by an autism
9393 specialist or an intensive individual service provider as such terms are
9494 defined by the Kansas department for aging and disability services Kansas
9595 autism waiver. On or after July 1, 2016, reimbursement shall be allowed
9696 only for services provided by an autism service provider licensed or
9797 exempt from licensure under the applied behavior analysis licensure act,
9898 except that reimbursement shall be allowed for services provided by an
9999 autism specialist, an intensive individual service provider or any other
100100 individual qualified to provide services under the home and community
101101 based services autism waiver administered by the Kansas department for
102102 aging and disability services.
103103 (5) Any insurer or other entity which that administers claims for
104104 services provided for the treatment of autism spectrum disorder under this
105105 section shall have the right and obligation to deny any claim for services
106106 based upon medical necessity or a determination that the covered
107107 individual has reached the maximum medical improvement for the covered
108108 individual's autism spectrum disorder.
109109 (6) Except for inpatient services, if an insured is receiving treatment
110110 for autism spectrum disorder, such insurer shall have the right to review
111111 the treatment plan not more than once in a period of six consecutive
112112 months, unless the insurer and the insured's treating physician or
113113 psychologist agree that a more frequent review is necessary. Any such
114114 agreement regarding the right to review a treatment plan more frequently
115115 shall apply only to a particular insured being treated for autism spectrum
116116 disorder and shall not apply to all individuals being treated for autism
117117 spectrum disorder by a physician or psychologist. The cost of obtaining
118118 any review or treatment plan shall be borne by the insurer.
119119 1
120120 2
121121 3
122122 4
123123 5
124124 6
125125 7
126126 8
127127 9
128128 10
129129 11
130130 12
131131 13
132132 14
133133 15
134134 16
135135 17
136136 18
137137 19
138138 20
139139 21
140140 22
141141 23
142142 24
143143 25
144144 26
145145 27
146146 28
147147 29
148148 30
149149 31
150150 32
151151 33
152152 34
153153 35
154154 36
155155 37
156156 38
157157 39
158158 40
159159 41
160160 42
161161 43 HB 2095 3
162162 (7) No insurer can terminate coverage, or refuse to deliver, execute,
163163 issue, amend, adjust or renew coverage to an individual solely because the
164164 individual is diagnosed with or has received treatment for autism spectrum
165165 disorder.
166166 (b) For the purposes of As used in this section:
167167 (1) "Applied behavior analysis" means the design, implementation
168168 and evaluation of environmental modifications, using behavioral stimuli
169169 and consequences, to produce socially significant improvement in human
170170 behavior, including the use of direct observation, measurement and
171171 functional analysis of the relationship between environment and behavior.
172172 (2) "Autism spectrum disorder" means a neurobiological disorder, an
173173 illness of the nervous system, which that includes:
174174 (A) "Autistic disorder," which is:
175175 (i) Six or more items from (a), (b) and (c) of this subparagraph, with
176176 at least two items from (a) of this subparagraph, and one item each from
177177 (b) and (c) of this subparagraph:
178178 (a) Qualitative impairment in social interaction, as manifested by at
179179 least two of the following:
180180 (1) Marked impairment in the use of multiple nonverbal behaviors
181181 such as eye-to-eye gaze, facial expression, body postures and gestures to
182182 regulate social interaction;
183183 (2) failure to develop peer relationships appropriate to developmental
184184 level;
185185 (3) a lack of spontaneous seeking to share enjoyment, interests or
186186 achievements with other people; or
187187 (4) lack of social or emotional reciprocity;
188188 (b) qualitative impairments in communication as manifested by at
189189 least one of the following:
190190 (1) Delay in, or total lack of, the development of spoken language;
191191 (2) in individuals with adequate speech, marked impairment in the
192192 ability to initiate or sustain a conversation with others;
193193 (3) stereotyped and repetitive use of language or idiosyncratic
194194 language; or
195195 (4) lack of varied, spontaneous make-believe play or social imitative
196196 play appropriate to developmental level;
197197 (c) restricted repetitive and stereotyped patterns of behavior, interests
198198 and activities, as manifested by at least one of the following:
199199 (1) Encompassing preoccupation with one or more stereotyped and
200200 restricted patterns of interest that is abnormal either in intensity or focus;
201201 (2) apparently inflexible adherence to specific, nonfunctional routines
202202 or rituals;
203203 (3) stereotyped and repetitive motor mannerisms; or
204204 (4) persistent preoccupation with parts of objects;
205205 1
206206 2
207207 3
208208 4
209209 5
210210 6
211211 7
212212 8
213213 9
214214 10
215215 11
216216 12
217217 13
218218 14
219219 15
220220 16
221221 17
222222 18
223223 19
224224 20
225225 21
226226 22
227227 23
228228 24
229229 25
230230 26
231231 27
232232 28
233233 29
234234 30
235235 31
236236 32
237237 33
238238 34
239239 35
240240 36
241241 37
242242 38
243243 39
244244 40
245245 41
246246 42
247247 43 HB 2095 4
248248 (ii) delays or abnormal functioning in at least one of the following
249249 areas, with onset prior to age three years, including social interaction,
250250 language as used in social communication or symbolic or imaginative
251251 play; and
252252 (iii) the disturbance is not better accounted for by Rett's disorder or
253253 childhood disintegrative disorder;
254254 (B) "Asperger's disorder," which is:
255255 (i) A qualitative impairment in social interaction, as manifested by at
256256 least two of the following:
257257 (a) Marked impairment in the use of multiple nonverbal behaviors
258258 such as eye-to-eye gaze, facial expression, body postures and gestures to
259259 regulate social interaction;
260260 (b) failure to develop peer relationships appropriate to developmental
261261 level;
262262 (c) lack of spontaneous seeking to share enjoyment, interests or
263263 achievements with other people; or
264264 (d) lack of social or emotional reciprocity;
265265 (ii) restricted repetitive and stereotyped patterns of behavior, interests
266266 and activities, as manifested by at least one of the following:
267267 (a) Encompassing preoccupation with one or more stereotyped and
268268 restricted patterns of interest that is abnormal either in intensity or focus;
269269 (b) apparently inflexible adherence to specific, nonfunctional routines
270270 or rituals;
271271 (c) stereotyped and repetitive motor mannerisms; or
272272 (d) persistent preoccupation with parts of objects;
273273 (iii) the disturbance causes clinically significant impairment in social,
274274 occupational or other important areas of functioning;
275275 (iv) there is no clinically significant general delay in language;
276276 (v) there is no clinically significant delay in cognitive development or
277277 in the development of age-appropriate self-help skills, adaptive behavior
278278 (other than in social interaction), and curiosity about the environment in
279279 childhood; and
280280 (vi) criteria are not met for another specific pervasive developmental
281281 disorder or schizophrenia;
282282 (C) "pervasive developmental disorder not otherwise specified," is a
283283 severe and pervasive impairment in the development of reciprocal social
284284 interaction associated with impairment in either verbal or nonverbal
285285 communication skills or with the presence of stereotyped behavior,
286286 interests and activities, but the criteria are not met for a specific pervasive
287287 developmental disorder, schizophrenia, schizotypal personality disorder, or
288288 avoidant personality disorder;
289289 (D) "Rett's disorder," includes:
290290 (i) All of the following:
291291 1
292292 2
293293 3
294294 4
295295 5
296296 6
297297 7
298298 8
299299 9
300300 10
301301 11
302302 12
303303 13
304304 14
305305 15
306306 16
307307 17
308308 18
309309 19
310310 20
311311 21
312312 22
313313 23
314314 24
315315 25
316316 26
317317 27
318318 28
319319 29
320320 30
321321 31
322322 32
323323 33
324324 34
325325 35
326326 36
327327 37
328328 38
329329 39
330330 40
331331 41
332332 42
333333 43 HB 2095 5
334334 (a) Apparently normal prenatal and perinatal development;
335335 (b) apparently normal psychomotor development through the first
336336 five months after birth; and
337337 (c) normal head circumference at birth;
338338 (ii) onset of all of the following after the period of normal
339339 development:
340340 (a) Deceleration of head growth between ages five and 48 months;
341341 (b) loss of previously acquired purposeful hand skills between ages
342342 five and 30 months with the subsequent development of stereotyped hand
343343 movements;
344344 (c) loss of social engagement early in the course of development;
345345 (d) appearance of poorly coordinated gait or trunk movements; and
346346 (e) severely impaired expressive and receptive language development
347347 with severe psychomotor retardation;
348348 (E) "childhood disintegrative disorder," is:
349349 (i) Apparently normal development for at least the first two years
350350 after birth as manifested by the presence of age-appropriate verbal and
351351 nonverbal communication, social relationships, play and adaptive
352352 behavior;
353353 (ii) clinically significant loss of previously acquired skills in at least
354354 two of the following areas: Expressive or receptive language, social skills
355355 or adaptive behavior, bowel or bladder control or play and motor skills;
356356 (iii) abnormalities of functioning in at least two of the following
357357 areas: Qualitative impairment in social interaction; qualitative impairments
358358 in communication; restricted, repetitive and stereotyped patterns of
359359 behavior, interests and activities, including motor stereotypies and
360360 mannerisms; and
361361 (iv) the disturbance is not better accounted for by another specific
362362 pervasive developmental disorder or by schizophrenia.
363363 (3) "Diagnosis of autism spectrum disorder" means any medically
364364 necessary assessment, evaluation or test performed by a licensed
365365 physician, licensed psychologist or licensed specialist clinical social
366366 worker to determine whether an individual has autism spectrum disorder.
367367 (4) "Grandfathered health benefit plan" shall have the meaning
368368 ascribed to such term means the same as defined in 42 U.S.C. § 18011.
369369 The term "grandfathered health benefit plan" includes both small employer
370370 group health benefit plans that are grandfathered and individual health
371371 benefit plans that are grandfathered.
372372 (5) "Health benefit plan" shall have the meaning ascribed to such
373373 term means the same as defined in K.S.A. 40-4602, and amendments
374374 thereto.
375375 (6) "Large employer" means, in connection with a group health
376376 benefit plan with respect to a calendar year and a plan year, an employer
377377 1
378378 2
379379 3
380380 4
381381 5
382382 6
383383 7
384384 8
385385 9
386386 10
387387 11
388388 12
389389 13
390390 14
391391 15
392392 16
393393 17
394394 18
395395 19
396396 20
397397 21
398398 22
399399 23
400400 24
401401 25
402402 26
403403 27
404404 28
405405 29
406406 30
407407 31
408408 32
409409 33
410410 34
411411 35
412412 36
413413 37
414414 38
415415 39
416416 40
417417 41
418418 42
419419 43 HB 2095 6
420420 who employed an average of at least 101 51 employees on business days
421421 during the preceding calendar year and who employs at least one employee
422422 on the first day of the plan year.
423423 (7) "Small employer" means, in connection with a group health
424424 benefit plan with respect to a calendar year and a plan year, an employer
425425 who employed an average of at least one two but not more than 100 50
426426 employees on business days during the preceding calendar year and who
427427 employs at least one employee on the first day of the plan year.
428428 (c) If an individual has been diagnosed as having autism spectrum
429429 disorder meeting the diagnostic criteria described in the edition of the
430430 diagnostic and statistical manual of mental disorders available at the time
431431 of diagnosis, then that individual shall not be required to undergo any
432432 additional or repeated evaluation based upon the adoption of a subsequent
433433 edition of the diagnostic and statistical manual of mental disorders adopted
434434 by rules and regulations of the behavioral sciences regulatory board in
435435 order to remain eligible for coverage under this section.
436436 (d) Except as otherwise provided in subsection (a), no individual or
437437 group health insurance policy, medical service plan, contract, hospital
438438 service corporation contract, hospital and medical service corporation
439439 contract, fraternal benefit society or health maintenance organization
440440 which that provides coverage for accident and health services and which
441441 provides coverage with respect to autism spectrum disorder shall impose
442442 on the coverage required by this section:
443443 (1) Impose on the coverage required by this section Any dollar limits,
444444 deductibles or coinsurance provisions that are less favorable to an insured
445445 than the dollar limits, deductibles or coinsurance provisions that apply to
446446 physical illness generally under the accident and sickness insurance policy;
447447 or
448448 (2) impose on the coverage required by this section Any limit upon
449449 the number of visits that a covered individual may make for treatment of
450450 autism spectrum disorder.
451451 (e) The provisions of this section shall not apply to any policy or
452452 certificate which that provides coverage for any specified disease,
453453 specified accident or accident-only coverage, credit, dental, disability
454454 income, hospital indemnity, long-term care insurance as defined by K.S.A.
455455 40-2227, and amendments thereto, vision care or any other limited
456456 supplemental benefit nor to any medicare supplement policy of insurance
457457 as defined by the commissioner of insurance by rules and regulations, any
458458 coverage issued as a supplement to liability insurance, workers'
459459 compensation or similar insurance, automobile medical-payment insurance
460460 or any insurance under which benefits are payable with or without regard
461461 to fault, whether written on a group, blanket or individual basis.
462462 (f) This section shall not be construed as limiting benefits that are
463463 1
464464 2
465465 3
466466 4
467467 5
468468 6
469469 7
470470 8
471471 9
472472 10
473473 11
474474 12
475475 13
476476 14
477477 15
478478 16
479479 17
480480 18
481481 19
482482 20
483483 21
484484 22
485485 23
486486 24
487487 25
488488 26
489489 27
490490 28
491491 29
492492 30
493493 31
494494 32
495495 33
496496 34
497497 35
498498 36
499499 37
500500 38
501501 39
502502 40
503503 41
504504 42
505505 43 HB 2095 7
506506 otherwise available to an individual under any individual or group health
507507 insurance policy, medical service plan, contract, hospital service
508508 corporation contract, hospital and medical service corporation contract,
509509 fraternal benefit society or health maintenance organization which
510510 provides coverage for accident and health services.
511511 (g) The provisions of K.S.A. 40-2249a, and amendments thereto,
512512 shall not apply to the provisions of this section.
513513 (h) The commissioner of the department of insurance shall grant a
514514 small employer with a group health benefit plan a waiver from the
515515 provisions of this section, if the small employer demonstrates to the
516516 commissioner by actual claims experience over any consecutive twelve-
517517 month 12-month period that compliance with this section has increased the
518518 cost of the health insurance policy by an amount of two and a half percent
519519 2.5% or greater over the period of a calendar year in premium costs to the
520520 small employer.
521521 (i) Nothing contained in this section shall require coverage for or
522522 payment of full or partial day care or habilitation services, community
523523 support services, services at intermediate care facilities, school-based
524524 rehabilitative services or overnight, boarding and extended stay services at
525525 facilities for autism patients. Only services actually rendered on an hourly
526526 basis or fractional portion thereof by certified applied behavior analysis
527527 (ABA) providers as herein defined shall be required to be covered under
528528 this section. Nothing in this section shall require coverage or payment
529529 hereunder for services that are otherwise provided, authorized or required
530530 to be provided by public or private schools receiving any state or federal
531531 funding for such services.
532532 Sec. 2. K.S.A. 40-2,194 is hereby repealed.
533533 Sec. 3. This act shall take effect and be in force from and after its
534534 publication in the statute book.
535535 1
536536 2
537537 3
538538 4
539539 5
540540 6
541541 7
542542 8
543543 9
544544 10
545545 11
546546 12
547547 13
548548 14
549549 15
550550 16
551551 17
552552 18
553553 19
554554 20
555555 21
556556 22
557557 23
558558 24
559559 25
560560 26
561561 27
562562 28
563563 29