Guam § 181101 - Definitions.

§ 181101. Definitions.

For the purposes of this Chapter:

(a) Autism spectrum disorder (ASD) means one (1)

of the three (3) following disorders as defined in the most

recent edition of the diagnostic and statistical manual of

mental disorders of the American Psychiatric Association:

(1) Autistic disorder;

(2) Asperger’s syndrome; or

(3) Pervasive developmental disorder—not

otherwise specified.

(b) 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.

(c) Behavioral health treatment means professional

services and treatment programs, including applied behavior

analysis and evidence-based behavior intervention

programs, that develop or restore, to the maximum extent

practicable, the functioning of an individual with autism

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spectrum disorder, and that meet all of the following

criteria:

(1) The treatment is prescribed by a physician or

surgeon duly licensed to practice on Guam, or is

developed by a psychiatrist or psychologist, any of

which shall be duly licensed to practice on Guam.

(2) The treatment is provided under a treatment

plan prescribed by a qualified ASD service provider

and is administered by one (1) of the following:

(A) a qualified ASD service provider;

(B) a qualified ASD service professional

supervised and employed by the qualified autism

spectrum disorder service provider; or

(C) an ASD service paraprofessional

supervised and employed by a qualified ASD

service provider.

(3) The treatment plan has measurable goals over

a specific timeline that is developed and approved by

the qualified ASD service provider for the specific

patient being treated. The treatment plan shall be

reviewed no less than once every six (6) months by the

qualified autism spectrum disorder service provider

and modified whenever appropriate, and shall be

consistent with all of the following items performed by

the qualified autism spectrum disorder service

provider, who:

(A) describes the patient’s behavioral health

impairments to be treated;

(B) designs an intervention plan that

includes the service type, number of hours, and

parent participation needed to achieve the plan’s

goal and objectives, and the frequency at which

the patient’s progress is evaluated and reported;

(C) provides intervention plans that utilize

evidence-based practices, with demonstrated

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clinical efficacy in treating autism spectrum

disorder; and

(D) discontinues intensive behavioral

intervention services when the treatment goals and

objectives are achieved or no longer appropriate.

(4) The treatment plan is not used for purposes

of providing or for the reimbursement of respite, day

care, or educational services, and is not used to

reimburse a parent for participating in the treatment

program. The treatment plan shall be made available to

the health care insurance service plan upon request.

(d) Qualified autism spectrum disorder service

provider means either of the following:

(1) a person, entity, or group that is certified by a

national entity, such as the Behavior Analyst

Certification Board, that is accredited by the National

Commission for Certifying Agencies, and who designs,

supervises, or provides treatment for autism spectrum

disorder, provided the services are within the

experience and competence of the person, entity, or

group that is nationally certified; or

(2) a person licensed pursuant to Part 1 or Part 2

of Chapter 12, 10 GCA as a physician or surgeon,

physical therapist, occupational therapist, psychologist,

marriage and family therapist, educational

psychologist, clinical social worker, professional

clinical counselor, speech-language pathologist, or

audiologist who designs, supervises, or provides

treatment or services for autism spectrum disorder,

provided the services are within the experience and

competence of the licensee.

(e) Small employer shall mean a business with less

than ten (10) employees.

(f) Bundling means combining various limited

benefit insurance policies, and advertising or indicating in

any manner that these policies are major medical expense

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coverage policies or could be substituted for major medical

expense coverage.

(g) Limited benefit coverage means an insurance

policy that is designed, advertised, and marketed to

supplement major medical insurance; and that includes

accident only, dental only, vision only, disability income

only, fixed or hospital indemnity, specified disease

insurance, credit insurance, or Taft-Hartley trusts.