20-1057.11. Health care services organizations; autism spectrum disorder; coverage; exceptions; definitions

249 words·~1 min read·/az/title-20/20-1057-11

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

A. A health care services organization shall not:

1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, assessment and services.

2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage, behavioral therapy services shall be provided or supervised by a licensed or certified provider.

B. This section does not:

1. Apply to an evidence of coverage that is issued to an individual or a small employer.

2. Apply to limited benefit coverage as defined in section 20-1137.

3. Require coverage for services provided outside of this state.

C. The coverage required by this section is subject to all the terms and conditions of the evidence of coverage. This section does not prevent an organization from imposing deductibles, coinsurance or other cost sharing in relation to the coverage required by this section.

D. For the purposes of this section:

1. "Autism spectrum disorder" means a pervasive, developmental disorder that meets the criteria for autism spectrum disorder as defined in the most recent edition of the diagnostic and statistical manual of mental disorders of the American psychiatric association.

2. "Behavioral therapy" means interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.

3. "Small employer" has the same meaning prescribed in section 20-2301.