Sen. James A. DeLeo
Filed: 4/8/2008
 
 

 




 

 		












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AMENDMENT TO SENATE BILL 1900




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    AMENDMENT NO. ______. Amend Senate Bill 1900, AS AMENDED, 
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with reference to page and line numbers of Senate Amendment No. 
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1 as follows:
 
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on page 6, immediately below line 2, by inserting the 
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following: 
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    "(f) Upon request of the reimbursing insurer, a provider of 
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treatment for autism spectrum disorders shall furnish medical 
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records, clinical notes, or other necessary data that 
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substantiate that initial or continued medical treatment is 
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medically necessary and is resulting in improved clinical 
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status.  When treatment is anticipated to require continued 
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services to achieve demonstrable progress, the insurer may 
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request a treatment plan consisting of diagnosis, proposed 
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treatment by type, frequency, anticipated duration of 
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treatment, the anticipated outcomes stated as goals, and the 
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frequency by which the treatment plan will be updated.
 


 






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    (g) When making a determination of medical necessity for a 
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treatment modality for autism spectrum disorders, an insurer 
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must make the determination in a manner that is consistent with 
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the manner used to make that determination with respect to 
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other diseases or illnesses covered under the policy, including 
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an appeals process.  During the appeals process, any challenge 
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to medical necessity must be viewed as reasonable only if the 
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review includes a physician with expertise in the most current 
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and effective treatment modalities for autism spectrum 
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disorders.
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    (h) Coverage for medically necessary early intervention 
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services must be delivered by certified early intervention 
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specialists, as defined in the early intervention operational 
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standards by the Department of Human Services and in accordance 
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with applicable certification requirements."; and
 
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on page 6, line 3, by replacing "(f)" with "(i)"; and
 
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on page 6, lines 12 through 13, by replacing "a certified, 
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registered, or licensed health care professional" with "a 
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licensed clinical psychologist"; and
 
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on page 6, line 17, by replacing "following;" with 
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"following:"; and
 
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on page 6, line 18, by replacing "disability." with 
 


 






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"disability;"; and
 
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on page 6, line 21, by replacing "disability." with 
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"disability; or"; and
 
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on page 7, line 6, by replacing "(A)" with "(1)"; and
 
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on page 7, line 7, by replacing "(B)" with "(2)"; and


 
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on page 7, line 8, by replacing "(C)" with "(3)"; and
 
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on page 7, line 9, by replacing "(D)" with "(4)"; and
 
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on page 7, line 15, by replacing "integration." with 
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"processing.".