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Bill > HSB74
IA HSB74
IA HSB74A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder.(See HF 243.)
summary
Introduced
01/20/2023
01/20/2023
In Committee
01/20/2023
01/20/2023
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 H.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 (autism) by removing age and financial limits on treatment. Specifically, it eliminates the previous age restrictions of 21 years for diagnostic assessment and treatment, and 19 years for applied behavior analysis (ABA), a common therapy for autism. It also removes the annual maximum benefit amounts, which were previously set at $36,000 for younger individuals and tiered amounts for older ones, meaning insurance plans will no longer have a cap on how much they will pay for autism treatment per year. The bill applies to insurance policies and plans delivered, renewed, or continued in the state starting January 1, 2024, and clarifies that coverage for ABA and other autism treatments should not have limits on the number of visits or aggregate annual/lifetime limits.
Committee Categories
Business and Industry
Sponsors (0)
No sponsors listed
Other Sponsors (1)
Commerce (House)
Last Action
Committee report approving bill, renumbered as HF 243. (on 02/08/2023)
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=HSB74 | 01/20/2023 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/90/attachments/HSB74.html | 01/20/2023 |
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