HF 330 — A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder and including applicability provisions.

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ilICulîlIV1'YIVIIIV9IClli1IIII:dlVII iCdï:dViIId d'{lI VLtllI I ICI[i House File 330 AN ACT RELATING TO INSURANCE COVERAGE FOR COVERED INDIVIDUALS FOR THE TREATMENT OF AUTISM SPECTRUM DISORDER AND INCLUDING APPLICABILITY PROVISIONS.

Auti3ticAutistic disorders Autism spectrum disorder.

22. .

Section 514C.22, subsection 44, , Code 2025, iis s amended to read as follows:

The commi3sioner,commissioner, by rule, shall define definitions of the biologically based mental illnesses identified in subsection 3.

Definition3Definitions cstabliekhedestablished by the ercommissioner R.shall be consistent with definitions provided in the most recent edition of the American psychiatric association’s diagnostic and statistical manual of mental disorders, as such definitions may be amended from time to time.

_.The commissioner may adopt the definitions provided in such manual by reference.

_.

_ shall be consistent with definitions provided in the most recent edition of the American psychiatric association 's diagnostic and statistical manual of mental disorders, as such definitions may be amended from time to time.

The eeffimssieeneer may adopt the definitions provided in such manual by reference.

33. .

Section 514C.22, subsection 77, , Code 2025, iis s amended by adding the following new paragraph:

NEW PARAGRAPH.PARAGRAPH .

Notwithstanding paragraphs „a„“a” and ­b-,“b”, a group policy, contract, or plan covered under this section shall not impose an aggregate annual or lifetime limit on biologically based mental illness coverage benefits for autism spectrum disorder.

House File 330, pp. .

Section 514C.22, subsection 88, , unnumbered paragraph 1, Code 2025, iis s amended to read as follows:

A group policy, contract, or plan covered under this section shall at a minimum allow for thirty inpatient days and fifty-two outpatient visits annually, and shall not limit the number of outpatient visits a covered individual may have with a practitioner for applied behavior analysis under section 514C.31, or with an autism service provider for treatment of autism spectrum disorder under section 514C.28.514C.28 .

Section 514C.28, subsections 11, , 3, and 5, Code 2025, are amended to read as follows:

Notwithstanding the uniformity of treatment requirements of section 514C.6, a group plan established pursuant to chapter 509A for employees of the state providing for third-party payment or prepayment of health, medical, and surgical coverage benefits shall provide coverage benefits to covered individuals under twenty-one yyears ar3 of age for the diagnostic assessment of autism spectrum disorder and for the treatment of autism spectrum disorder.

Coverage --­is required pursuant to this section in a maximum benefit amount of not more than thirtythirty-six six thousand dollar3dollars per year but shall not be subject to any limits on the number of visits to a covered individual may have with an autism service provider for treatment of autism spectrum disorder.

The eemmissienercommissioner shall, enon or beferebefore April 1 of each calendar year, publish an adjustment to the maximum benefit required equal teto the tagepercentage change in the United States department of labor consumer price index for all urban consumers in the preceding year, and the published adjusted maximum benefit Shallshall be applicable to group policic3,policies, contracts, or plans subject to this section that are i33ucdissued House File 330, pp. .

3 or renewed on or after January 1 of the following alendarcalendar year.

Payments made-made under a group plan subject to this section on behalf of a covered individual for treatment of a health maximscondition unrelated to or distinguishable from the individual’s autism spectrum disorder shall not be applied toward any maximum benefit cwtab1i^shed--underestablished thrs—subseetionunder 5.this subsection.

Coverage5. required by this section shall be provided in coordination with coverage required for the treatment of auti3tic disorders autism spectrum disorder pursuant to section 514C.22.

Coverage required by this section shall be provided in coordination with coverage required for the treatment of autistic disorders autism spectrum disorder pursuant to section 514C.22.

Section 514C.28, subsection 22, , paragraph c, Code 2025, is amended to read as follows:

C,c. Autism spectrum disorder - means a mental health eenditien —that—rn_to the diagno3tic criteria for such disorder otatiotical manual of mental disordero a3 publi3hed by the Ameri an p3ychiatric association the same as defined in section 514C.22, subsection 4 .

“Autism spectrum disorder” means a mental health condition that meets the diagnostic criteria for such disorder as published in the most recent edition of the diagnostic and statistical manual of mental disorders as published by the American psychiatric association the same as defined in section 514C.22, subsection 4 .

Section 514C.31, subsection 11, , unnumbered paragraph 1, Code 2025, is amended to read as follows:

Notwithstanding the uniformity of treatment requirements of section 514C.6, a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits shall provide coverage benefits for applied behavior analysis provided by a practitioner to covered individuals under nineteen yyears ar3 of age for the treatment of autism spectrum disorder pursuant to a treatment plan if the policy, contract, or plan is either of the following:

Section8. 514C.31, subsection 3 , Code 2025, is amended by striking the subsection.

Section 514C.31, subsection 3, Code 2025, is amended by striking the subsection.

Section 514C.31, subsections 4 and 55, , Code 2025, are amended to read as follows:

Coverage required pursuant to this section may be subject to dollar limits, deductibles, copayments, or coinsurance provisions that apply to other medical and surgical services under the policy, contract, or plan, subject to the requirements of 3ubseetionsubsection 33. .

4 policy, contract, or plan, including prior authorization—,authorization, and prior approval, and limits on the number of visits a covered individual may make for applied behavior analysi3.analysis .