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Bill > SSB1050
IA SSB1050
IA SSB1050A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder.
summary
Introduced
01/17/2023
01/17/2023
In Committee
01/17/2023
01/17/2023
Crossed Over
Passed
Dead
04/16/2024
04/16/2024
Introduced Session
90th General Assembly
Bill Summary
This bill relates to insurance coverage for covered individuals for the treatment of autism spectrum disorder (autism). Under current law, a group plan established pursuant to Code chapter 509A for employees of the state that provides for third-party payment or prepayment of health, medical, and surgical coverage benefits (coverage) shall provide coverage to covered individuals under 21 years of age for the diagnostic assessment and treatment of autism, and coverage is required in a maximum benefit amount of not more than $36,000 per year. The bill eliminates the 21-year maximum age limit and the maximum benefit amount. Under current law, a group policy, contract, or plan (policy) providing for third-party payment or prepayment of health, medical, and surgical coverage shall provide coverage for applied behavior analysis (analysis) provided by a practitioner to covered individuals under 19 years of age for the treatment of autism pursuant to a treatment plan if the policy is either a policy issued by a carrier to an employer who on at least 50 percent of the employer’s working days during the preceding calendar year employed more than 50 full-time equivalent employees, or the policy is established pursuant to Code chapter 509A for public employees other than employees of the state. Under the bill, the age restriction is eliminated. Current law requires that the coverage for analysis shall provide an annual maximum benefit of not less S.F. _____ than $36,000 for individuals through age six, $25,000 for individuals age seven through 13, and $12,500 for individuals age 14 through 18. The bill eliminates the maximum benefit amounts and the age categories. The bill makes conforming changes to Code section 514C.22. The bill applies to third-party payment providers enumerated in the bill. The types of specialized health-related insurance which are not subject to the bill are specified in the bill. The bill applies to plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024.
AI Summary
This Study Bill aims to expand and improve insurance coverage for individuals with autism spectrum disorder by removing age restrictions and financial limits on certain treatments. Specifically, it eliminates the previous age caps of 21 and 19 for diagnostic assessments and treatments, and for applied behavior analysis (ABA), respectively, meaning coverage will no longer be limited to younger individuals. Furthermore, the bill removes the annual maximum benefit amounts that were previously in place for these treatments, such as the $36,000 yearly limit for state employees' children under 21 and tiered annual limits for ABA based on age. The bill also clarifies that insurance policies will not be allowed to impose aggregate annual or lifetime limits on coverage for autism spectrum disorder treatments and will not limit the number of outpatient visits for ABA or other autism treatments, ensuring more comprehensive and continuous care for individuals of all ages. These changes are set to apply to insurance plans delivered, issued, continued, or renewed in the state on or after January 1, 2024.
Committee Categories
Business and Industry
Sponsors (0)
No sponsors listed
Other Sponsors (1)
Commerce (Senate)
Last Action
Senate (13:00:00 2/14/2023 ) (on 02/14/2023)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location | Created |
|---|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=SSB1050 | 01/17/2023 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/90/attachments/SSB1050.html | 01/17/2023 |
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