H. B. No. 8 As Introduced

Cosponsors: Representatives Okey, Harris, Dyer, Foley, Lundy, Harwood, Koziura, Stebelton, Hagan, Skindell, Stewart, Heard, Mallory, DeBose, Patten, Pryor, Yuko, Pillich, Newcomb, Murray, Phillips, Winburn, Letson, Bolon, Luckie, Williams, B., Slesnick

Sec. 1739.05. (A) A multiple employer welfare arrangement	9
that is created pursuant to sections 1739.01 to 1739.22 of the	10
Revised Code and that operates a group self-insurance program may	11
be established only if any of the following applies:	12

(1) The arrangement has and maintains a minimum enrollment of	13
three hundred employees of two or more employers.	14

(2) The arrangement has and maintains a minimum enrollment of	15
three hundred self-employed individuals.	16

(3) The arrangement has and maintains a minimum enrollment of	17
three hundred employees or self-employed individuals in any	18
combination of divisions (A)(1) and (2) of this section.	19

(B) A multiple employer welfare arrangement that is created	20
pursuant to sections 1739.01 to 1739.22 of the Revised Code and	21
that operates a group self-insurance program shall comply with all	22
laws applicable to self-funded programs in this state, including	23
sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381	24
to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14,	25
3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3923.80,	26
3923.84, 3924.031, 3924.032, and 3924.27 of the Revised Code.	27

Section 1. That section 1739.05 be amended and sections	6
1751.68 and 3923.84 of the Revised Code be enacted to read as	7
follows:	8

(C) A multiple employer welfare arrangement created pursuant	28
to sections 1739.01 to 1739.22 of the Revised Code shall solicit	29
enrollments only through agents or solicitors licensed pursuant to	30
Chapter 3905. of the Revised Code to sell or solicit sickness and	31
accident insurance.	32

(D) A multiple employer welfare arrangement created pursuant	33
to sections 1739.01 to 1739.22 of the Revised Code shall provide	34
benefits only to individuals who are members, employees of	35
members, or the dependents of members or employees, or are	36
eligible for continuation of coverage under section 1751.53 or	37
3923.38 of the Revised Code or under Title X of the "Consolidated	38
Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29	39
U.S.C.A. 1161, as amended.	40

Sec. 1751.68. (A) Notwithstanding section 3901.71 of the	41
Revised Code, no health insuring corporation policy, contract, or	42
agreement that provides basic health care services that is	43
delivered, issued for delivery, or renewed in this state shall	44
exclude coverage for any of the following services when those	45
services are medically necessary and are prescribed, provided, or	46
ordered for an individual diagnosed with an autism spectrum	47
disorder by a health care professional licensed or certified	48
under the laws of this state to prescribe, provide, or order such	49
services:	50

(7) Any additional treatments or therapies adopted by the	57
director of health pursuant to division (H)(4) of section 3923.84	58
of the Revised Code.	59

(B) Coverage provided under this section shall not be subject	60
to any limits on the number or duration of visits an individual	61
may make to any autism service provider.	62

(C) Coverage provided under this section may be subject to	63
any copayment, deductible, and coinsurance provisions of the	64
policy, contract, or agreement to the extent that other medical	65
services covered by the health benefit plan are subject to those	66
provisions.	67

(D) Not more than once every twelve months, a health insuring	68
corporation may request a review of any treatment provided under	69
this section except inpatient services unless the insured's	70
licensed physician or licensed psychologist agrees that more	71
frequent review is necessary. The health insuring corporation	72
shall pay for any review requested under this division.	73

(E) This section shall not be construed as limiting benefits	74
otherwise available under an individual's policy, contract, or	75
agreement.	76

(F) This section shall not be construed as affecting any	77
obligation to provide services to an individual under an	78
individualized family service plan developed under 20 U.S.C. 1436	79
or individualized service plan developed under section 5126.31 of	80
the Revised Code, or affecting the duty of a public school to	81
provide a child with a disability with a free appropriate public	82
education under the "Individuals with Disabilities Education	83
Improvement Act of 2004," 20 U.S.C. 1400 et seq., as amended, and	84
Chapter 3323. of the Revised Code.	85

(1) "Applied behavior analysis" means the design,	87
implementation, and evaluation of environmental modifications	88
using behavioral stimuli and consequences to produce socially	89
significant improvement in human behavior, including, but not	90
limited to, the use of direct observation, measurement, and	91
functional analysis of the relationship between environment and	92
behavior.	93

(3) "Autism spectrum disorder" means any of the pervasive	96
developmental disorders as defined by the most recent edition of	97
the diagnostic and statistical manual of mental disorders,	98
published by the American psychiatric association, or if that	99
manual is no longer published, a similar diagnostic manual. Autism	100
spectrum disorders includes, but is not limited to, autistic	101
disorder, Asperger's disorder, Rett's disorder, childhood	102
disintegrative disorder, and pervasive developmental disorder.	103

(4) "Diagnosis of autism spectrum disorders" means medically	104
necessary assessments, evaluations, or tests, including but not	105
limited to genetic and psychological tests to determine whether an	106
individual has an autism spectrum disorder.	107

(5) "Habilitative or rehabilitative care" means professional,	108
counseling, and guidance services and treatment programs,	109
including applied behavior analysis, that are necessary to	110
develop, maintain, or restore the functioning of an individual to	111
the maximum extent practicable.	112

(2) "Autism services provider" means any person that provides	94
treatment of autism spectrum disorders.	95

(6) "Medically necessary" means the service is based upon	113
evidence; is prescribed, provided, or ordered by a health care	114
professional licensed or certified under the laws of this state to	115
prescribe, provide, or order autism-related services in accordance	116
with accepted standards of practice; and will or is reasonably	117
expected to do any of the following:	118

(a) Prevent the onset of an illness, condition, injury, or	119
disability;	120

(b) Reduce or ameliorate the physical, mental or	121
developmental effects of an illness, condition, injury, or	122
disability;	123

(c) Assist in achieving or maintaining maximum functional	124
capacity for performing daily activities, taking into account both	125
the functional capacity of the individual and the appropriate	126
functional capacities of individuals of the same age.	127

(7) "Pharmacy care" means prescribed medications and any	128
medically necessary health-related services used to determine the	129
need or effectiveness of the medications.	130

(8) "Psychiatric care" means direct or consultative services	131
provided by a psychiatrist licensed in the state in which the	132
psychiatrist practices psychiatry.	133

(9) "Psychological care" means direct or consultative	134
services provided by a psychologist licensed in the state in which	135
the psychologist practices psychology.	136

(10) "Therapeutic care" means services or communication	137
devices provided by a licensed speech-language pathologist,	138
licensed occupational therapist, or licensed physical therapist.	139

Sec. 3923.84. (A) Notwithstanding section 3901.71 of the	140
Revised Code, no individual or group policy of sickness and	141
accident insurance that is delivered, issued for delivery, or	142
renewed in this state or public employee benefit plan established	143
or modified in this state shall exclude coverage for any of the	144
following services when those services are medically necessary	145
and are prescribed, provided, or ordered for an individual	146
diagnosed with an autism spectrum disorder by a health care	147
professional licensed or certified under the laws of this state to	148
prescribe, provide, or order such services:	149

(C) Coverage provided under this section may be subject to	161
any copayment, deductible, and coinsurance provisions of the	162
health benefit plan to the extent that other medical services	163
covered by the policy or plan are subject to those provisions.	164

(D) Not more than once every twelve months, an insurer may	165
request a review of any treatment provided under this section	166
except inpatient services unless the insured's licensed physician	167
or licensed psychologist agrees that more frequent review is	168
necessary. The insurer shall pay for any review requested under	169
this division.	170

(G) This section does not apply to the offer or renewal of	182
any individual or group policy of sickness and accident insurance	183
that provides coverage for specific diseases or accidents only, or	184
to any hospital indemnity, medicare supplement, medicare, tricare,	185
long-term care, disability income, one-time limited duration	186
policy of not longer than six months, or other policy that offers	187
only supplemental benefits.	188

(H)(1) The commission on autism spectrum disorders is hereby	189
established as an independent commission in the department of	190
health to investigate and recommend treatments or therapies for	191
autism spectrum disorders that the commission believes should be	192
included in the services that health benefit plans and public	193
employee benefit plans are required to cover under division (A) of	194
this section.	195

(2) The commission shall consist of 10 members appointed by	196
the director of health including at least one licensed physician,	197
licensed psychologist, and parent of an individual diagnosed with	198
an autism spectrum disorder.	199

(3) The commission shall serve at the pleasure of the	200
director.	201

(4) At the recommendation of the commission, the director may	202
adopt rules to include additional treatments or therapies for	203
autism spectrum disorders in the services that health benefit	204
plans and public employee benefit plans are required to cover	205
under division (A) of this section.	206

(6) "Health benefit plan" has the same meaning as in section	234
3924.01 of the Revised Code.	235

(7) "Medically necessary" means the service is based upon	236
evidence; is prescribed, provided, or ordered by a health care	237
professional licensed or certified under the laws of this state to	238
prescribe, provide, or order autism-related services in accordance	239
with accepted standards of practice; and will or is reasonably	240
expected to do any of the following:	241

(8) "Pharmacy care" means prescribed medications and any	251
medically necessary health-related services used to determine the	252
need or effectiveness of the medications.	253