SB 1074 - This act specifies that third-party payers for health care services shall not limit or deny coverage for treatment of symptoms and behaviors for physically or developmentally disabled individuals if a licensed physician or psychologist determines the symptoms or behaviors caused by the disability require the individual to receive care or assistance from another person and directly affect participation in everyday activities.
The act adds coverage for developmental and physical disabilities to the autism spectrum disorder health insurance coverage mandate. The act specifies that medical necessity of treatment shall be determined by the health benefit plan, and that providers may submit a treatment plan.
Coverage for therapeutic care required to be provided under the act shall be subject to a maximum benefit of $40,000 per calendar year for individuals through the age of 18. This limit may be exceeded upon prior approval by the health benefit plan if medically necessary.
This act is similar to HB 1658 (2018), SB 456 (2017), and HB 1011 (2017).
ERIC VANDER WEERD