SENATE PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR

SENATE BILL 197

48th legislature - STATE OF NEW MEXICO - first session, 2007

AN ACT

RELATING TO HEALTH INSURANCE; REQUIRING THAT HEALTH INSURANCE POLICIES INCLUDE COVERAGE FOR AUTISM SPECTRUM DISORDER.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     Section 1. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER.--

          A. An individual or group health insurance policy, health care plan, certificate of health insurance or managed health care plan delivered or issued for delivery in this state shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder. This coverage shall be a basic health care benefit and shall entitle each individual to the medically accepted standard of medical care and treatment for autism spectrum disorder, including skill-building therapies, speech therapy, occupational therapy and social skills development therapy.

          B. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies.

          C. Coverage for individuals with autism spectrum disorder may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given contract.

          D. For purposes of this section, "autism spectrum disorder" means a neurobiological condition that includes autistic disorder, Asperger disorder or pervasive developmental disorder not otherwise specified."

     Section 2. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER.--

          A. A blanket or group health insurance policy, health care plan, certificate of health insurance or managed health care plan delivered or issued for delivery in this state shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder. This coverage shall be a basic health care benefit and shall entitle each individual to the medically accepted standard of medical care and treatment for autism spectrum disorder, including skill-building therapies, speech therapy, occupational therapy and social skills development therapy.

          B. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies.

          C. Coverage for individuals with autism spectrum disorder may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given contract.

          D. For purposes of this section, "autism spectrum disorder" means a neurobiological condition that includes autistic disorder, Asperger disorder or pervasive developmental disorder not otherwise specified."

     Section 3. A new section of Chapter 59A, Article 46 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER.--

          A. An individual or group health maintenance organization contract delivered or issued for delivery in this state shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder. This coverage shall be a basic health care benefit and shall entitle each individual to the medically accepted standard of medical care and treatment for autism spectrum disorder, including skill-building therapies, speech therapy, occupational therapy and social skills development therapy.

          B. Coverage for individuals with autism spectrum disorder may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given contract.

          C. For purposes of this section, "autism spectrum disorder" means a neurobiological condition that includes autistic disorder, Asperger disorder or pervasive developmental disorder not otherwise specified."

     Section 4. A new section of Chapter 59A, Article 47 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER.--

          A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder. This coverage shall be a basic health care benefit and shall entitle each individual to the medically accepted standard of medical care and treatment for autism spectrum disorder, including skill- building therapies, speech therapy, occupational therapy and social skills development therapy.

          B. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies.

          C. Coverage for individuals with autism spectrum disorder may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given contract.

          D. For purposes of this section, "autism spectrum disorder" means a neurobiological condition that includes autistic disorder, Asperger disorder or pervasive developmental disorder not otherwise specified."

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