Bill > A354

Introduced Session

This bill defines "autism" and adds certain requirements concerning health benefits coverage for autism and other developmental disabilities. The bill also adds requirements concerning health benefits coverage for central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder. The bill amends P.L.2009, c.115, which requires certain health benefits coverage for diagnosing and treating autism and other developmental disabilities, by defining "autism" to include any one of several related conditions commonly classified under pervasive developmental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) or the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). These related conditions include: autism spectrum disorder; autistic disorder; Asperger's disorder; childhood disintegrative disorder; pervasive developmental disorder not otherwise specified or unspecified pervasive developmental disorder; fragile X syndrome and Rett's disorder, to the extent that either condition is comorbid with pervasive developmental disorder; and any other equivalent conditions. The bill also requires that health care practitioners, as defined pursuant to the bill, use the DSM IV-TR to render an autism diagnosis and requires that health insurers maintain an individual's eligibility for health benefits coverage even if an autism diagnosis is rendered under an updated version of the DSM IV-TR. The bill newly requires health insurers to provide coverage for occupational therapy, physical therapy, and speech therapy related to treating central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder. The bill also newly requires health insurers to provide coverage for applied behavioral analysis interventions related to treating social communication disorder. The insurers and programs to which the provisions of this bill apply include: health, hospital and medical service corporations; commercial individual and group health insurers; health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs; health maintenance organizations; the State Health Benefits Program; and the School Employees' Health Benefits Program. The bill requires attorneys' fees to be awarded under successful claims demonstrating that an insurer or program has failed to comply with the provisions of the bill.

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Daniel Benson (D)*,  Sean Kean (R)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/27/2016)