Rhode Island General Laws 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 occupational therapy and psychology, psychiatry, and pharmaceutical services shall be, to the extent such services are a covered benefit for other diseases and conditions under such policy; and
(2) Applied behavior analysis.
Terms Used In Rhode Island General Laws 27-20.11-3
- 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. See Rhode Island General Laws 27-20.11-2
- Autism spectrum disorders: means any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. See Rhode Island General Laws 27-20.11-2
- carrier: means any entity subject to the insurance laws and regulations of this state, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical service corporation, or any other entity subject to chapter 18, 19, 20, or 41 of this title, providing a plan of health insurance, health benefits, or health services. See Rhode Island General Laws 27-20.11-2
(b) Benefits under this section shall continue until the covered individual reaches age fifteen (15).
(c) The healthcare benefits outlined in this chapter apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this chapter outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carrier‘s network.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1; P.L. 2012, ch. 371, § 1; P.L. 2012, ch. 397, § 1; P.L. 2015, ch. 141, art. 5, § 5.