Arizona Laws 20-1057.11. Health care services organizations; autism spectrum disorder; coverage; exceptions; definitions
A. A health care services organization shall not:
Terms Used In Arizona Laws 20-1057.11
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Evidence of coverage: means any certificate, agreement or contract issued to an enrollee and setting out the coverage to which the enrollee is entitled. See Arizona Laws 20-1051
- Health care services: means services for the purpose of diagnosing, preventing, alleviating, curing or healing human illness or injury. See Arizona Laws 20-1051
- including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
- Person: means any natural or artificial person including individuals, partnerships, associations, providers of health care, trusts, insurers, hospital or medical service corporations or other corporations, prepaid group practice plans, foundations for medical care and health maintenance organizations. See Arizona Laws 20-1051
- Provider: means any physician, hospital or other person that is licensed or otherwise authorized to furnish health care services in this state. See Arizona Laws 20-1051
- Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, assessment and services.
2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage, behavioral therapy services shall be provided or supervised by a licensed or certified provider.
B. This section does not:
1. Apply to an evidence of coverage that is issued to an individual or a small employer.
2. Apply to limited benefit coverage as defined in section 20-1137.
3. Require coverage for services provided outside of this state.
C. The coverage required by this section is subject to all the terms and conditions of the evidence of coverage. Nothing in this section prevents an organization from imposing deductibles, coinsurance or other cost sharing in relation to the coverage required by this section.
D. Coverage for behavioral therapy is subject to:
1. A fifty thousand dollar maximum benefit per year for an eligible person up to the age of nine.
2. A twenty-five thousand dollar maximum benefit per year for an eligible person who is between the ages of nine and sixteen.
E. For the purposes of this section:
1. "Autism spectrum disorder" means one of the three following disorders as defined in the most recent edition of the diagnostic and statistical manual of mental disorders of the American psychiatric association:
(a) Autistic disorder.
(b) Asperger’s syndrome.
(c) Pervasive developmental disorder – not otherwise specified.
2. "Behavioral therapy" means interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.
3. "Small employer" has the same meaning prescribed in section 20-2301.