§ 27-20.11-1. Mandatory coverage for Autism spectrum disorders. (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2012, shall provide coverage for autism spectrum disorders; provided, […]
§ 27-20.11-2. Definitions. As used in this chapter: (1) “Applied behavior analysis” means the design, implementation and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior, including the use of direct observation, measurement and functional analysis of the relationship between environment and behavior. (2) “Autism spectrum disorders” […]
§ 27-20.11-3. Scope of coverage. (a) Benefits under this section shall include coverage for pharmaceuticals, applied behavior analysis, physical therapy, speech therapy, psychology, psychiatric and occupational therapy services for the treatment of Autism spectrum disorders, as defined in the most recent edition of the DSM. Provided, however: (1) Coverage for physical therapy, speech therapy and […]
§ 27-20.11-4. Medical necessity and appropriateness of treatment. (a) Upon request of the reimbursing health insurance carrier, all providers shall furnish medical records or other necessary data which substantiates that initial or continued treatment is at all times medically necessary and appropriate. (b) Medical necessity criteria may be based in part on evidence of continued […]
§ 27-20.11-5. Limits on cost sharing. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each health insurance carrier. Except as otherwise provided in this section, any policy, contract or certificate that provides coverage for services under this section may contain provisions for maximum […]
§ 27-20.11-6. Educational and other services provided to children diagnosed with Autism spectrum disorders. Nothing in this section shall be construed to alter any obligation of a school district or the state of Rhode Island to provide services to an individual under an individualized family service plan or an individualized education program, as required under […]
§ 27-20.11-7. Credentials. (a) Any individual providing or supervising applied behavior analysis treatment under this section shall be: (1) Individually licensed by the department of health as a licensed applied behavior analyst; or a licensed applied behavior assistant analyst acting under supervision; or (2) Licensed by the department of health as a psychologist with equivalent […]
§ 27-20.11-8. Exclusions. This chapter shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies. […]
