CT Family Support Council

General Assembly File No. 187

The Committee on Insurance and Real Estate reported through

REP. O’CONNOR of the 35th Dist., Chairperson of the

Committee on the part of the House, that the substitute bill

ought to pass.

Be it enacted by the Senate and House of Representatives in General

Assembly convened:

1 Section 1. (NEW) (Effective January 1, 2009) Each individual health

2 insurance policy providing coverage of the type specified in

3 subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general

4 statutes that is delivered, issued for delivery, renewed, amended or

5 continued in this state on or after January 1, 2009, shall provide

6 coverage for physical therapy, speech therapy and occupational

7 therapy services for the treatment of autism spectrum disorders, as set

8 forth in the most recent edition of the American Psychiatric

9 Association’s “Diagnostic and Statistical Manual of Mental Disorders”,

10 to the extent such services are a covered benefit for other diseases and

11 conditions under such policy.

12 Sec. 2. (NEW) (Effective January 1, 2009) Each group health insurance

13 policy providing coverage of the type specified in subdivisions (1), (2),

14 (4), (11) and (12) of section 38a-469 of the general statutes that is

15 delivered, issued for delivery, renewed, amended or continued in this

16 state on or after January 1, 2009, shall provide coverage for physical

17 therapy, speech therapy and occupational therapy services for the

18 treatment of autism spectrum disorders, as set forth in the most recent

19 edition of the American Psychiatric Association’s “Diagnostic and

20 Statistical Manual of Mental Disorders”, to the extent such services are

21 a covered benefit for other diseases and conditions under such policy.

This act shall take effect as follows and shall amend the following

sections:

Section 1 January 1, 2009 New section

Sec. 2 January 1, 2009 New section

The following fiscal impact statement and bill analysis are prepared for the benefit of members of the

General Assembly, solely for the purpose of information, summarization, and explanation, and do not

represent the intent of the General Assembly or either chamber thereof for any purpose:

State Comptroller – state

employee health service cost

Various - Cost None See Below

Various Municipalities Cost Potential Potential

The bill may impact the state employee health plan costs when the

required coverage becomes effective in FY 10. It is not clear at this

time if state employee health plans provide all the therapy coverage

mandated by the bill. The bill’s impact on state plan coverage and any

impact to the state’s FY 10 premium is under review by the actuary

and is not available at this time.

The bill may impact municipalities that have fully insured health

plans that do not currently cover the therapies required by the bill.

The required coverage may result in increased premium costs when

the municipalities enter into new contracts for health insurance.

The annualized ongoing fiscal impact identified above would

continue into the future subject to inflation.

AN ACT REQUIRING INSURANCE COVERAGE FOR AUTISM

This bill requires health insurance policies delivered, issued,

renewed, amended, or continued in Connecticut on or after January 1,

2009 to cover physical, speech, and occupational therapy services

provided to treat autism spectrum disorders if the policies cover these

services for other diseases and conditions. It defines “autism spectrum

disorder” as the American Psychiatric Association’s most recent

Diagnostic and Statistical Manual of Mental Disorders uses the phrase.

It applies this requirement to group and individual (1) health

insurance policies that cover basic hospital, medical-surgical, or major

medical expenses; (2) HMO contracts covering hospital and medical

expenses; and (3) hospital or medical service contracts. Due to federal

law, this requirement does not apply to self-insured plans.

EFFECTIVE DATE: January 1, 2009

The American Psychiatric Association’s most recent , DSM-IV-TR (fourth edition, text

revision), refers to autism as a pervasive developmental disorder, more

often referred to today as autism spectrum disorder (ASD). ASD

ranges from a severe form, called autistic disorder, to a milder form,

Asperger syndrome. If a child has symptoms of either but does not

meet the specific diagnostic criteria, the diagnosis is called pervasive

developmental disorder not otherwise specified. Other rare, very

severe disorders that ASD includes are Rett syndrome and childhood

disintegrative disorder. An estimated 3.4 of every 1,000 children age

three to 10 have ASD (National Institutes of Health, NIH).

ASD can often be reliably diagnosed by age three, is often associated

with some degree of mental retardation, and sometimes observed with

a diverse group of general medical conditions. ASD characteristics

include varying degrees of impaired social interaction; verbal and

nonverbal communication problems; and unusual, repetitive, or

severely limited activities and interests (NIH). The DSM-IV-TR

explicitly differentiates ASD from other diagnostic categories,

including learning, motor skills, communication, and attention deficit

disorders.

Existing law requires insurance coverage for the

diagnosis and treatment of mental or nervous conditions. It defines

“mental or nervous conditions” as mental disorders, as it is used in the

DSM-IV-TR. It specifically excludes (1) mental retardation, (2)

learning, motor skills, communication, and caffeine-related disorders,

(3) relational problems, and (4) additional conditions not otherwise

defined as mental disorders in the DSM-IV-TR (CGS §§ 38a-488a and

38a-514).

Birth-to-Three. By law, insurance must cover medically necessary

early intervention services for a child from birth until age three that are

part of an individualized family service plan. Coverage is limited to

$3,200 maximum per child per year, up to $9,600 for the three years

(CGS §§ 38a-490a and 38a-516a).

Occupational Therapy. Existing law requires insurance coverage

for occupational therapy if the policy covers physical therapy (CGS §§

38a-496 and 38a-524).

Autism Spectrum Services Division. Public Act 07-4, JSS, (§§ 105-

114) creates the Autism Spectrum Services Division in the Department

of Mental Retardation (DMR) to research, design, and implement

appropriate, necessary services and programs for residents with ASD.

The Insurance and Real Estate Committee reported:

1. sSB 280, requiring (a) insurance coverage for bone marrow

testing and prosthetics and (b) a cost-benefit study of

Connecticut health insurance mandates and

2. sSB 478, requiring full insurance coverage for preventive care.

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea 19 Nay 0 (03/11/2008)