Nevada § 287.0276 - Coverage for screening for and diagnosis and treatment of autism spectrum disorders required to be provided by local governmental agency that provides health insurance through plan of self-insurance

§ 287.0276. Coverage for screening for and diagnosis and treatment of autism spectrum disorders required to be provided by local governmental agency that provides health insurance through plan of self-insurance

1. The governing body of any county, school district, municipal corporation, political

subdivision, public corporation or other local governmental agency of the State of

Nevada that provides health insurance through a plan of self-insurance must provide

coverage for screening for and diagnosis of autism spectrum disorders and for treatment

of autism spectrum disorders to persons covered by the plan of self-insurance under

the age of 18 years or, if enrolled in high school, until the person reaches the age

of 22 years. 2. Coverage provided under this section is subject to: (a) A maximum benefit of the actuarial equivalent of $72,000 per year for applied

behavior analysis treatment; and (b) Copayment, deductible and coinsurance provisions and any other general exclusion

or limitation of a plan of self-insurance to the same extent as other medical services

or prescription drugs covered by the policy. 3. A governing body of any county, school district, municipal corporation, political

subdivision, public corporation or other local governmental agency of the State of

Nevada that provides health insurance through a plan of self-insurance which provides

coverage for outpatient care shall not: (a) Require an insured to pay a higher deductible, copayment or coinsurance or require

a longer waiting period for coverage for outpatient care related to autism spectrum

disorders than is required for other outpatient care covered by the plan of self-insurance;

or (b) Refuse to issue a plan of self-insurance or cancel a plan of self-insurance solely

because the person applying for or covered by the plan of self-insurance uses or may

use in the future any of the services listed in subsection 1. 4. Except as otherwise provided in subsections 1 and 2, a governing body of any county,

school district, municipal corporation, political subdivision, public corporation

or other local governmental agency of the State of Nevada that provides health insurance

through a plan of self-insurance shall not limit the number of visits an insured may

make to any person, entity or group for treatment of autism spectrum disorders. 5. Treatment of autism spectrum disorders must be identified in a treatment plan and

may include medically necessary habilitative or rehabilitative care, prescription

care, psychiatric care, psychological care, behavioral therapy or therapeutic care

that is: (a) Prescribed for a person diagnosed with an autism spectrum disorder by a licensed

physician or licensed psychologist; and (b) Provided for a person diagnosed with an autism spectrum disorder by a licensed

physician, licensed psychologist, licensed behavior analyst or other provider that

is supervised by the licensed physician, psychologist or behavior analyst. A governing body of any county, school district, municipal corporation, political

subdivision, public corporation or other local governmental agency of the State of

Nevada that provides health insurance through a plan of self-insurance may request

a copy of and review a treatment plan created pursuant to this subsection. 6. A plan of self-insurance subject to the provisions of this chapter that is delivered,

issued for delivery or renewed on or after July 1, 2011, has the legal effect of including

the coverage required by subsection 1, and any provision of the plan of self-insurance

or the renewal which is in conflict with subsection 1 or 2 is void. 7. Nothing in this section shall be construed as requiring a governing body of any

county, school district, municipal corporation, political subdivision, public corporation

or other local governmental agency of the State of Nevada that provides health insurance

through a plan of self-insurance to provide reimbursement to a school for services

delivered through school services. 8. As used in this section: (a) “ Applied behavior analysis ” means the design, implementation and evaluation of environmental modifications using

behavioral stimuli and consequences to produce socially significant improvement in

human behavior, including, without limitation, the use of direct observation, measurement

and functional analysis of the relations between environment and behavior. (b) “Autism spectrum disorder” has the meaning ascribed to it in NRS 427A.875 . (c) “ Behavioral therapy ” means any interactive therapy derived from evidence-based research, including, without

limitation, discrete trial training, early intensive behavioral intervention, intensive

intervention programs, pivotal response training and verbal behavior provided by a

licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst

or registered behavior technician. (d) “ Evidence-based research ” means research that applies rigorous, systematic and objective procedures to obtain

valid knowledge relevant to autism spectrum disorders. (e) “ Habilitative or rehabilitative care ” means counseling, guidance and professional services and treatment programs, including,

without limitation, applied behavior analysis, that are necessary to develop, maintain

and restore, to the maximum extent practicable, the functioning of a person. (f) “ Licensed assistant behavior analyst ” has the meaning ascribed to the term “assistant behavior analyst” in NRS 641D.020 . (g) “ Licensed behavior analyst ” has the meaning ascribed to the term “behavior analyst” in NRS 641D.030 . (h) “ Prescription care ” means medications prescribed by a licensed physician and any health-related services

deemed medically necessary to determine the need or effectiveness of the medications. (i) “ Psychiatric care ” means direct or consultative services provided by a psychiatrist licensed in the

state in which the psychiatrist practices. (j) “ Psychological care ” means direct or consultative services provided by a psychologist licensed in the

state in which the psychologist practices. (k) “Registered behavior technician” has the meaning ascribed to it in NRS 641D.090 . (l) “ Screening for autism spectrum disorders ” means all medically appropriate assessments, evaluations or tests to diagnose whether

a person has an autism spectrum disorder. (m) “ Therapeutic care ” means services provided by licensed or certified speech-language pathologists, occupational

therapists and physical therapists. (n) “ Treatment plan ” means a plan to treat an autism spectrum disorder that is prescribed by a licensed

physician or licensed psychologist and may be developed pursuant to a comprehensive

evaluation in coordination with a licensed behavior analyst.