SB1900sam002 95TH GENERAL ASSEMBLY

Sen. James A. DeLeo

Filed: 4/8/2008

09500SB1900sam002 LRB095 16815 RPM 48864 a

AMENDMENT TO SENATE BILL 1900

AMENDMENT NO. ______. Amend Senate Bill 1900, AS AMENDED, with reference to page and line numbers of Senate Amendment No. 1 as follows:

on page 6, immediately below line 2, by inserting the following:

"(f) Upon request of the reimbursing insurer, a provider of treatment for autism spectrum disorders shall furnish medical records, clinical notes, or other necessary data that substantiate that initial or continued medical treatment is medically necessary and is resulting in improved clinical status. When treatment is anticipated to require continued services to achieve demonstrable progress, the insurer may request a treatment plan consisting of diagnosis, proposed treatment by type, frequency, anticipated duration of treatment, the anticipated outcomes stated as goals, and the frequency by which the treatment plan will be updated.

(g) When making a determination of medical necessity for a treatment modality for autism spectrum disorders, an insurer must make the determination in a manner that is consistent with the manner used to make that determination with respect to other diseases or illnesses covered under the policy, including an appeals process. During the appeals process, any challenge to medical necessity must be viewed as reasonable only if the review includes a physician with expertise in the most current and effective treatment modalities for autism spectrum disorders.

(h) Coverage for medically necessary early intervention services must be delivered by certified early intervention specialists, as defined in the early intervention operational standards by the Department of Human Services and in accordance with applicable certification requirements."; and

on page 6, line 3, by replacing "(f)" with "(i)"; and

on page 6, lines 12 through 13, by replacing "a certified, registered, or licensed health care professional" with "a licensed clinical psychologist"; and

on page 6, line 17, by replacing "following;" with "following:"; and

on page 6, line 18, by replacing "disability." with "disability;"; and

on page 6, line 21, by replacing "disability." with "disability; or"; and

on page 7, line 6, by replacing "(A)" with "(1)"; and

on page 7, line 7, by replacing "(B)" with "(2)"; and

on page 7, line 8, by replacing "(C)" with "(3)"; and

on page 7, line 9, by replacing "(D)" with "(4)"; and

on page 7, line 15, by replacing "integration." with "processing.".