Well, autism is making another appearance in the General Assembly this year. This bill is being introduced by Delegate Bob Marshall, requiring insurers to cover autism. I very much would like to see this bill make it out of committee. If you are a Virginia voter, contact your delegate today to ask them to co-sponsor this important bill. I sent an e-mail to Jackson Miller, my delegate to ask him to do the same. I will keep you posted as to his response.
Referred to Committee on Commerce and Labor
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Be it enacted by the General Assembly of Virginia:
1. That § 38.2-4319 of the Code of Virginia is amended and reenacted and
that the Code of Virginia is amended by adding a section numbered
38.2-4318.15 as follows:
§38.2-3418.15. Coverage for habilitative services for children.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing
to issue individual or group accident or sickness insurance policies
providing hospital, medical and surgical, or major medical coverage on an
expense-incurred basis; corporation providing individual or group accident
or sickness subscription contracts; and health maintenance organization
providing a health care plan for health care services shall provide
coverage under any such policy, contract, or plan delivered, issued for
delivery, or renewed in the Commonwealth on and after July 1, 2008, for
medically necessary habilitative services for persons younger than 19
years.
B. For the purposes of this section:
"Habilitative services" means health and social services directed toward
increasing and maintaining the physical, intellectual, emotional, and
social functioning of developmentally delayed individuals, including
occupational, physical, and speech therapy; assistance, training,
supervision, and monitoring in the areas of self-care, sensory and motor
development, interpersonal skills, communication, and socialization; and
reduction or elimination of maladaptive behavior. "Habilitative services"
does not include services for which coverage is provided or required to be
provided pursuant to § 38.2-3418.5.
"Medically necessary habilitative services" means habilitative services
that are certified by the Department of Mental Health, Mental Retardation
and Substance Abuse Services as designed to help an individual attain or
retain the capability to function age appropriately within the
individual's environment and shall include habilitative services that
enhance functional ability without effecting a cure.
C. An insurer, corporation, or health maintenance organization subject to
this section shall not be required to provide coverage for medically
necessary habilitative services to the extent that such services are
provided through the individual's school; however, this exclusion from
coverage shall not alter or diminish the obligation of an insurer,
corporation, or health maintenance organization to provide coverage for
medically necessary habilitative services that are not provided through
the individual's school.
D. An insurer, corporation, or health maintenance organization subject to
this section shall provide notice annually to its insured and enrollees
about coverage required under this section.
E. The provisions of this section shall not apply to short-term travel,
accident-only, limited or specified disease policies, contracts designed
for issuance to persons eligible for coverage under Title XVIII of the
Social Security Act, know as Medicare, or any other similar coverage under
state or federal governmental plans, or to short-term nonrenewable
policies of not more than six months' duration.
§ 38.2-4319. Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they
are not inconsistent with this chapter, §§ 38.2-100, 38.2-136, 38.2-200,
38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through 38.2-225,
38.2-229, 38.2-232, 38.2-305, 38.2-316, 38.2-322, 38.2-400, 38.2-402
through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620,
Chapter 9 (§ 38.2-900 et seq.), §§ 38.2-1016.1 through 38.2-1023,
38.2-1057, Article 2 (§ 38.2-1306.2 et seq.), § 38.2-1306.1, §
38.2-1315.1, Articles 3.1 (§ 38.2-1316.1 et seq.), 4 (§ 38.2-1317 et seq.)
and 5 (§ 38.2-1322 et seq.) of Chapter 13, Articles 1 (§ 38.2-1400 et
seq.) and 2 (§ 38.2-1412 et seq.) of Chapter 14, §§ 38.2-1800 through
38.2-1836, 38.2-3401, 38.2-3405, 38.2-3405.1, 38.2-3407.2 through
38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16, 38.2-3411.2, 38.2-3411.3,
38.2-3411.4, 38.2-3412.1:01, 38.2-3414.1, 38.2-3418.1 through
38.2-3418.1434.2-3418.15, 38.2-3419.1, 38.2-3430.1 through 38.2-3437,
38.2-3500, subdivision 13 of § 38.2-3503, subdivision 8 of § 38.2-3504, §§
38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525,
38.2-3540.1, 38.2-3542, 38.2-3543.2, Article 5 (§ 38.2-3551 et seq.) of
Chapter 35, Chapter 52 (§ 38.2-5200 et seq.), Chapter 55 (§ 38.2-5500 et
seq.), Chapter 58 (§ 38.2-5800 et seq.) and § 38.2-5903 of this title
shall be applicable to any health maintenance organization granted a
license under this chapter. This chapter shall not apply to an insurer or
health services plan licensed and regulated in conformance with the
insurance laws or Chapter 42 (§ 38.2-4200 et seq.) of this title except
with respect to the activities of its health maintenance organization.
B. For plans administered by the Department of Medical Assistance Services
that provide benefits pursuant to Title XIX or Title XXI of the Social
Security Act, as amended, no provisions of this title except this chapter
and, insofar as they are not inconsistent with this chapter, §§ 38.2-100,
38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216,
38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-322, 38.2-400,
38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through
38.2-620, Chapter 9 (§ 38.2-900 et seq.), §§ 38.2-1016.1 through
38.2-1023, 38.2-1057, § 38.2-1306.1, Article 2 (§ 38.2-1306.2 et seq.), §
38.2-1315.1, Articles 3.1 (§ 38.2-1316.1 et seq.), 4 (§ 38.2-1317 et seq.)
and 5 (§ 38.2-1322 et seq.) of Chapter 13, Articles 1 (§ 38.2-1400 et
seq.) and 2 (§ 38.2-1412 et seq.) of Chapter 14, §§ 38.2-3401, 38.2-3405,
38.2-3407.2 through 38.2-3407.5, 38.2-3407.6 and 38.2-3407.6:1,
38.2-3407.9, 38.2-3407.9:01, and 38.2-3407.9:02, subdivisions 1, 2, and 3
of subsection F of § 38.2-3407.10, 38.2-3407.11, 38.2-3407.11:3,
38.2-3407.13, 38.2-3407.13:1, and 38.2-3407.14, 38.2-3411.2, 38.2-3418.1,
38.2-3418.2, 38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3500,
subdivision 13 of § 38.2-3503, subdivision 8 of § 38.2-3504, §§
38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525,
38.2-3540.1, 38.2-3542, 38.2-3543.2, Chapter 52 (§ 38.2-5200 et seq.),
Chapter 55 (§ 38.2-5500 et seq.), Chapter 58 (§ 38.2-5800 et seq.) and §
38.2-5903 shall be applicable to any health maintenance organization
granted a license under this chapter. This chapter shall not apply to an
insurer or health services plan licensed and regulated in conformance with
the insurance laws or Chapter 42 (§ 38.2-4200 et seq.) of this title
except with respect to the activities of its health maintenance
organization.
C. Solicitation of enrollees by a licensed health maintenance organization
or by its representatives shall not be construed to violate any provisions
of law relating to solicitation or advertising by health professionals.
D. A licensed health maintenance organization shall not be deemed to be
engaged in the unlawful practice of medicine. All health care providers
associated with a health maintenance organization shall be subject to all
provisions of law.
E. Notwithstanding the definition of an eligible employee as set forth in
§ 38.2-3431, a health maintenance organization providing health care plans
pursuant to § 38.2-3431 shall not be required to offer coverage to or
accept applications from an employee who does not reside within the health
maintenance organization's service area.
F. For purposes of applying this section, "insurer" when used in a section
cited in subsections A and B of this section shall be construed to mean
and include "health maintenance organizations" unless the section cited
clearly applies to health maintenance organizations without such
construction.
§ 38.2-4319. Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they
are not inconsistent with this chapter, §§ 38.2-100, 38.2-136, 38.2-200,
38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through 38.2-225,
38.2-229, 38.2-232, 38.2-305, 38.2-316, 38.2-322, 38.2-400, 38.2-402
through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620,
Chapter 9 (§ 38.2-900 et seq.), §§ 38.2-1016.1 through 38.2-1023,
38.2-1057, Article 2 (§ 38.2-1306.2 et seq.), § 38.2-1306.1, §
38.2-1315.1, Articles 3.1 (§ 38.2-1316.1 et seq.), 4 (§ 38.2-1317 et seq.)
and 5 (§ 38.2-1322 et seq.) of Chapter 13, Articles 1 (§ 38.2-1400 et
seq.) and 2 (§ 38.2-1412 et seq.) of Chapter 14, §§ 38.2-1800 through
38.2-1836, 38.2-3401, 38.2-3405, 38.2-3405.1, 38.2-3407.2 through
38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16, 38.2-3411.2, 38.2-3411.3,
38.2-3411.4, 38.2-3412.1:01, 38.2-3414.1, 38.2-3418.1 through
38.2-3418.1438.2-3418.15, 38.2-3419.1, 38.2-3430.1 through 38.2-3437,
38.2-3500, subdivision 13 of § 38.2-3503, subdivision 8 of § 38.2-3504, §§
38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525,
38.2-3540.1, 38.2-3542, 38.2-3543.2, Article 5 (§ 38.2-3551 et seq.) of
Chapter 35, Chapter 52 (§ 38.2-5200 et seq.), Chapter 55 (§ 38.2-5500 et
seq.), Chapter 58 (§ 38.2-5800 et seq.) and § 38.2-5903 of this title
shall be applicable to any health maintenance organization granted a
license under this chapter. This chapter shall not apply to an insurer or
health services plan licensed and regulated in conformance with the
insurance laws or Chapter 42 (§ 38.2-4200 et seq.) of this title except
with respect to the activities of its health maintenance organization.
B. For plans administered by the Department of Medical Assistance Services
that provide benefits pursuant to Title XIX or Title XXI of the Social
Security Act, as amended, no provisions of this title except this chapter
and, insofar as they are not inconsistent with this chapter, §§ 38.2-100,
38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216,
38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-322, 38.2-400,
38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through
38.2-620, Chapter 9 (§ 38.2-900 et seq.), §§ 38.2-1016.1 through
38.2-1023, 38.2-1057, § 38.2-1306.1, Article 2 (§ 38.2-1306.2 et seq.), §
38.2-1315.1, Articles 3.1 (§ 38.2-1316.1 et seq.), 4 (§ 38.2-1317 et seq.)
and 5 (§ 38.2-1322 et seq.) of Chapter 13, Articles 1 (§ 38.2-1400 et
seq.) and 2 (§ 38.2-1412 et seq.) of Chapter 14, §§ 38.2-3401, 38.2-3405,
38.2-3407.2 through 38.2-3407.5, 38.2-3407.6 and 38.2-3407.6:1,
38.2-3407.9, 38.2-3407.9:01, and 38.2-3407.9:02, subdivisions 1, 2, and 3
of subsection F of § 38.2-3407.10, 38.2-3407.11, 38.2-3407.11:3,
38.2-3407.13, 38.2-3407.13:1, and 38.2-3407.14, 38.2-3411.2, 38.2-3418.1,
38.2-3418.2, 38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3500,
subdivision 13 of § 38.2-3503, subdivision 8 of § 38.2-3504, §§
38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525,
38.2-3540.1, 38.2-3542, 38.2-3543.2, Chapter 52 (§ 38.2-5200 et seq.),
Chapter 55 (§ 38.2-5500 et seq.), Chapter 58 (§ 38.2-5800 et seq.) and §
38.2-5903 shall be applicable to any health maintenance organization
granted a license under this chapter. This chapter shall not apply to an
insurer or health services plan licensed and regulated in conformance with
the insurance laws or Chapter 42 (§ 38.2-4200 et seq.) of this title
except with respect to the activities of its health maintenance
organization.
C. Solicitation of enrollees by a licensed health maintenance organization
or by its representatives shall not be construed to violate any provisions
of law relating to solicitation or advertising by health professionals.
D. A licensed health maintenance organization shall not be deemed to be
engaged in the unlawful practice of medicine. All health care providers
associated with a health maintenance organization shall be subject to all
provisions of law.
E. Notwithstanding the definition of an eligible employee as set forth in
§ 38.2-3431, a health maintenance organization providing health care plans
pursuant to § 38.2-3431 shall not be required to offer coverage to or
accept applications from an employee who does not reside within the health
maintenance organization's service area.
F. For purposes of applying this section, "insurer" when used in a section
cited in subsections A and B of this section shall be construed to mean
and include "health maintenance organizations" unless the section cited
clearly applies to health maintenance organizations without such
construction.
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