Archived | The General Assembly Of Pennsylvania: House Bill No. 1150 Session of 2007 | Circa July 13, 2007 #LegislationWithoutRepresentation #NotAnAutisticAlly

        PRIOR PRINTER'S NOS. 1448, 2237               PRINTER'S NO. 2326

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 1150 Session of 2007


        INTRODUCED BY D. O'BRIEN, DeWEESE, PALLONE, PHILLIPS, RAPP,
           SCAVELLO, STURLA, BAKER, BASTIAN, BOYD, BROOKS, CALTAGIRONE,
           CARROLL, CLYMER, COHEN, CONKLIN, DALEY, DALLY, DeLUCA,
           DePASQUALE, DONATUCCI, EVERETT, FREEMAN, GEIST, GEORGE,
           GIBBONS, GINGRICH, GOODMAN, GRUCELA, HALUSKA, HARKINS,
           HENNESSEY, HERSHEY, JAMES, JOSEPHS, KAUFFMAN, W. KELLER,
           KENNEY, KIRKLAND, KOTIK, KULA, LEACH, LENTZ, MAHONEY,
           MANDERINO, MANN, MARKOSEK, MARSHALL, McILHATTAN, MOYER, MURT,
           MUSTIO, McGEEHAN, MYERS, NAILOR, M. O'BRIEN, PASHINSKI,
           PAYNE, PETRONE, PRESTON, READSHAW, REICHLEY, ROSS, SCHRODER,
           SEIP, SHAPIRO, SHIMKUS, M. SMITH, SOLOBAY, SONNEY, STABACK,
           STEIL, SURRA, TANGRETTI, TRUE, VEREB, WATSON, J. WHITE,
           WOJNAROSKI, YUDICHAK, MACKERETH, MANTZ, BARRAR, HORNAMAN,
           CAUSER, WALKO, HELM, MELIO, DENLINGER, BRENNAN, RAMALEY,
           DiGIROLAMO, GERGELY, M. KELLER, FRANKEL, FABRIZIO,
           YOUNGBLOOD, REED, ROAE, CURRY, K SMITH, GALLOWAY, SIPTROTH
           AND RUBLEY APRIL 30, 2007

        AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
           JULY 13, 2007

                                     AN ACT

     1  Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
     2     act relating to insurance; amending, revising, and
     3     consolidating the law providing for the incorporation of
     4     insurance companies, and the regulation, supervision, and
     5     protection of home and foreign insurance companies, Lloyds
     6     associations, reciprocal and inter-insurance exchanges, and
     7     fire insurance rating bureaus, and the regulation and
     8     supervision of insurance carried by such companies,
     9     associations, and exchanges, including insurance carried by
    10     the State Workmen's Insurance Fund; providing penalties; and
    11     repealing existing laws," providing, in health and accident
    12     insurance, for autism spectrum disorders coverage and for
    13     treatment of autism spectrum disorders; and further providing
    14     for quality health care procedures.

    15     The General Assembly of the Commonwealth of Pennsylvania
    16  hereby enacts as follows:

     1     Section 1.  The act of May 17, 1921 (P.L.682, No.284), known
     2  as The Insurance Company Law of 1921, is amended by adding
     3  sections to read:
     4     Section 635.2.  Autism Spectrum Disorders Coverage.--(a)  A
     5  health insurance policy or government program shall provide to
     6  covered individuals or recipients under twenty-one years of age
     7  coverage for the diagnosis of autism spectrum disorders and for
     8  the treatment of autism spectrum disorders. TO THE EXTENT THAT    <--
     9  THE DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDERS ARE NOT
    10  ALREADY COVERED BY THE HEALTH INSURANCE POLICY OR GOVERNMENT
    11  PROGRAM, COVERAGE UNDER THIS SECTION SHALL BE INCLUDED IN HEALTH
    12  INSURANCE POLICIES AND CONTRACTS UNDER A GOVERNMENT PROGRAM
    13  WHICH ARE DELIVERED, EXECUTED, ISSUED, AMENDED, ADJUSTED OR
    14  RENEWED ON OR AFTER ONE HUNDRED EIGHTY DAYS FROM THE EFFECTIVE
    15  DATE OF THIS SECTION, EXCEPT THAT THE APPLICABILITY OF THIS
    16  SECTION TO GOVERNMENT PROGRAMS SHALL BE CONTINGENT UPON FEDERAL
    17  APPROVAL IF NECESSARY.
    18     (b)  Except for the Commonwealth's medical assistance program
    19  established under the act of June 13, 1967 (P.L.31, No.21),
    20  known as the "Public Welfare Code," and except for the
    21  Children's Health Care Program established under this act,
    22  coverage provided under this section shall be subject to a
    23  maximum benefit of thirty-six thousand dollars ($36,000) per
    24  year but shall not be subject to any limits on the number of
    25  visits to an autism service provider. After December 30, 2009,
    26  the Insurance Commissioner shall, on an annual basis, adjust the
    27  maximum benefit for inflation using the Medical Price Index       <--
    28  (MPI) component of the Department of Labor Consumer Price Index
    29  (CPI). CARE COMPONENT OF THE UNITED STATES DEPARTMENT OF LABOR    <--
    30  CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS (CPI-U). The
    20070H1150B2326                  - 2 -     

     1  commissioner shall submit the adjusted maximum benefit to the
     2  Legislative Reference Bureau for publication annually in the
     3  Pennsylvania Bulletin no later than April 1 of each calendar
     4  year, and the published adjusted maximum benefit shall be
     5  applicable in the following calendar year to health insurance
     6  policies and government programs subject to this act. Payments
     7  made by an insurer on behalf of a covered individual for any
     8  care, treatment, intervention, service or item, the provision of
     9  which was for the treatment of a health condition unrelated to
    10  the covered individual's autism spectrum disorder, shall not be
    11  applied toward any maximum benefit established under this
    12  subsection.
    13     (c)  Coverage under this section shall be subject to
    14  copayment, deductible and coinsurance provisions of a health
    15  insurance policy or government program to the extent that other
    16  medical services covered by the policy or government program are
    17  subject to these provisions.
    18     (d)  This section shall not be construed as limiting benefits
    19  which are otherwise available to an individual under a health
    20  insurance policy.
    21     (e)  This section shall not apply to the following types of
    22  policies:
    23     (1)  Accident only.
    24     (2)  Limited benefit.
    25     (3)  Credit.
    26     (4)  Dental.
    27     (5)  Vision.
    28     (6)  Specified disease.
    29     (7)  Medicare supplement.
    30     (8)  CHAMPUS (Civilian Health and Medical Program of the
    20070H1150B2326                  - 3 -     

     1  Uniformed Services) supplement.
     2     (9)  Long-term care or disability income.
     3     (10)  Workers' compensation.
     4     (11)  Automobile medical payment.
     5     (12)  Hospital indemnity.
     6     (f)  As used in this section:
     7     (1)  "Applied behavioral analysis" means the design,
     8  implementation and evaluation of environmental modifications,
     9  using behavioral stimuli and consequences, to produce socially
    10  significant improvement in human behavior, including the use of
    11  direct observation, measurement and functional analysis of the
    12  relations between environment and behavior.
    13     (2)  "Autism service provider" means any person, entity or
    14  group that provides treatment of autism spectrum disorders.
    15     (3)  "Autism spectrum disorders" means any of the pervasive
    16  developmental disorders as defined by the most recent edition of
    17  the Diagnostic and Statistical Manual of Mental Disorders (DSM),
    18  including autistic disorder, Asperger's disorder and pervasive
    19  developmental disorder not otherwise specified.
    20     (4)  "Diagnosis of autism spectrum disorders" means medically
    21  necessary assessments, evaluations or tests in order to diagnose
    22  whether an individual has an autism spectrum disorder.
    23     (5)  "Evidenced-based research" means research that applies
    24  rigorous, systematic and objective procedures to obtain valid
    25  knowledge relevant to autism spectrum disorders.
    26     (6)  "Government program" means any of the following:
    27     (i)  The Commonwealth's medical assistance program
    28  established under the act of June 13, 1967 (P.L.31, No.21),
    29  known as the "Public Welfare Code."
    30     (ii)  The adult basic coverage insurance program established
    20070H1150B2326                  - 4 -     

     1  under Chapter 13 of the act of June 26, 2001 (P.L.755, No.77),
     2  known as the "Tobacco Settlement Act."
     3     (iii)  The Children's Health Care Program established under
     4  this act.
     5     (7)  "Health insurance policy" means any group health,
     6  sickness or accident policy or subscriber contract or
     7  certificate issued by an insurance entity subject to one of the
     8  following:
     9     (i)  This act.
    10     (ii)  The act of December 29, 1972 (P.L.1701, No.364), known
    11  as the "Health Maintenance Organization Act."
    12     (iii)  The act of May 18, 1976 (P.L.123, No.54), known as the
    13  "Individual Accident and Sickness Insurance Minimum Standards
    14  Act."
    15     (iv)  40 Pa.C.S. Ch. 61 (relating to hospital plan
    16  corporations) or 63 (relating to professional health services
    17  plan corporations).
    18     (8)  "Medically necessary" means any care, treatment,
    19  intervention, service or item which is prescribed, provided or
    20  ordered by a licensed physician, licensed psychologist or
    21  certified registered nurse practitioner in accordance with
    22  accepted standards of practice and which will, or is reasonably
    23  expected to, do any of the following:
    24     (i)  Prevent the onset of an illness, condition, injury or
    25  disability.
    26     (ii)  Reduce or ameliorate the physical, mental or
    27  developmental effects of an illness, condition, injury or
    28  disability.
    29     (iii)  Assist to achieve or maintain maximum functional
    30  capacity in performing daily activities, taking into account
    20070H1150B2326                  - 5 -     

     1  both the functional capacity of the recipient and those
     2  functional capacities that are appropriate of recipients of the
     3  same age.
     4     (9)  "Pharmacy care" means medications prescribed by a
     5  licensed physician or certified registered nurse practitioner
     6  and any health-related services deemed medically necessary to
     7  determine the need or effectiveness of the medications.
     8     (10)  "Psychiatric care" means direct or consultative
     9  services provided by a psychiatrist licensed in the state in
    10  which the psychiatrist practices.
    11     (11)  "Psychological care" means direct or consultative
    12  services provided by a licensed psychologist PSYCHOLOGIST         <--
    13  LICENSED in the state in which the psychologist practices.
    14     (12)  "Rehabilitative care" means professional, counseling
    15  and guidance services and treatment programs, including applied
    16  behavioral analysis, which are necessary to develop, maintain
    17  and restore, to the maximum extent practicable, the functioning
    18  of an individual.
    19     (13)  "Therapeutic care" means services provided by licensed
    20  or certified speech therapists, occupational therapists or
    21  physical therapists.
    22     (14)  "Treatment for autism spectrum disorders" shall include
    23  the following care prescribed, provided or ordered for an
    24  individual diagnosed with an autism spectrum disorder by a
    25  licensed physician, licensed psychologist or certified
    26  registered nurse practitioner if the care is determined to be
    27  medically necessary:
    28     (i)  Psychiatric care.
    29     (ii) Psychological care.
    30     (iii)  Rehabilitative care.
    20070H1150B2326                  - 6 -     

     1     (iv)  Therapeutic care.
     2     (v)  Pharmacy care.
     3     (vi)  Any care, treatment, intervention, service or item for
     4  individuals with an autism spectrum disorder which is determined
     5  by the Department of Public Welfare, based upon its review of
     6  best practices or evidenced-based research, to be medically
     7  necessary and which is published in the Pennsylvania Bulletin.
     8  Any such care, treatment, intervention, service or item which
     9  was not previously covered shall be included in any health
    10  insurance policy or contract under a government program
    11  delivered, issued, executed or renewed on or after 120 days
    12  following the date of its publication in the Pennsylvania
    13  Bulletin.
    14     (g)  The Department of Public Welfare shall promulgate
    15  regulations establishing standards for qualified autism service
    16  providers. For purposes of implementing this section, and
    17  notwithstanding any other provision of law, THE Secretary of      <--
    18  Public Welfare shall promulgate regulations pursuant to section
    19  204(1)(iv) of the act of July 31, 1968 (P.L.769, No.240),
    20  referred to as the Commonwealth Documents Law, which shall, for
    21  120 days from the effective date of this act, be exempt from all
    22  OF the following acts:                                            <--
    23     (1)  Section 205 of the Commonwealth Documents Law.
    24     (2)  Section 204(b) of the act of October 15, 1980 (P.L.950,
    25  No.164), known as the "Commonwealth Attorneys Act."
    26     (3)  The act of June 25, 1982 (P.L.633, No.181), known as the
    27  "Regulatory Review Act."
    28  Once the regulations are promulgated, payment for the treatment
    29  of autism spectrum disorders covered under this section shall
    30  only be made to autism service providers who meet the standards.
    20070H1150B2326                  - 7 -     

     1     (h)  To the extent that the diagnosis and treatment of autism  <--
     2  spectrum disorders are not already covered by the health
     3  insurance policy or government program, coverage under this
     4  section shall be included in health insurance policies and
     5  contracts under a government program which are delivered,
     6  executed, issued, amended, adjusted or renewed on or after one
     7  hundred twenty days from the effective date of this section,
     8  except that the applicability of this section to government
     9  programs shall be contingent upon Federal approval if necessary.
    10     Section 2116.1.  Treatment of Autism Spectrum Disorders.--(a)
    11  Except for government programs, if an enrollee has obtained a
    12  referral or other authorization through utilization review from
    13  a managed care plan or a licensed insurer to receive any care,
    14  treatment, intervention, service or item for an autism spectrum
    15  disorder from a health care provider or specialist, the referral
    16  or other authorization shall constitute a standing referral for
    17  any subsequent care, treatment, intervention, service or item
    18  provided by any health care provider or specialist until the
    19  care, treatment, intervention, service or item for which the
    20  referral or authorization was approved has reached its
    21  conclusion.
    22     SECTION 2116.1.  TREATMENT OF AUTISM SPECTRUM DISORDERS.--(A)  <--
    23  EXCEPT FOR INPATIENT SERVICES, IF AN ENROLLEE HAS OBTAINED
    24  AUTHORIZATION THROUGH UTILIZATION REVIEW FROM A MANAGED CARE
    25  PLAN, GOVERNMENT PROGRAM OR A LICENSED INSURER TO RECEIVE ANY
    26  CARE, TREATMENT, INTERVENTION, SERVICE OR ITEM FOR AN AUTISM
    27  SPECTRUM DISORDER, THE AUTHORIZATION SHALL BE VALID FOR TWELVE
    28  MONTHS, UNLESS THE ENROLLEE'S PRIMARY CARE PROVIDER DETERMINES
    29  THAT AN EARLIER RE-EVALUATION IS NECESSARY IN ORDER TO
    30  ADEQUATELY ADDRESS THE CLINICAL NEEDS OF THE ENROLLEE.
    20070H1150B2326                  - 8 -     

     1     (A.1)  IN APPLYING SUBSECTION (A), IF WITHIN THE TWELVE-MONTH
     2  PERIOD FOLLOWING THE EFFECTIVE DATE OF THIS SECTION A HEALTH
     3  INSURANCE POLICY IS DELIVERED, ISSUED, EXECUTED OR RENEWED AND
     4  AT THE TIME OF SUCH DELIVERY, ISSUANCE, EXECUTION OR RENEWAL AN
     5  ENROLLEE IS RECEIVING ANY INPATIENT OR OUTPATIENT CARE,
     6  TREATMENT, INTERVENTION, SERVICE OR ITEM FOR AN AUTISM SPECTRUM
     7  DISORDER PURSUANT TO AN AUTHORIZATION OBTAINED FROM A GOVERNMENT
     8  PROGRAM, AND THE CARE, TREATMENT, INTERVENTION, SERVICE OR ITEM
     9  IS COVERED UNDER THE HEALTH INSURANCE POLICY BEING DELIVERED,
    10  ISSUED, EXECUTED OR RENEWED, THE AUTHORIZATION FROM THE
    11  GOVERNMENT PROGRAM SHALL REMAIN VALID FOR THE REMAINDER OF THE
    12  EXISTING AUTHORIZATION PERIOD AS TO ANY MANAGED CARE PLAN OR
    13  PRIVATE INSURER AND SUCH AUTHORIZATION SHALL BE HONORED BY ANY
    14  MANAGED CARE PLAN OR PRIVATE INSURER PROVIDING COVERAGE TO THE
    15  ENROLLEE.
    16     (b)  If a health care provider provides care, treatments,
    17  interventions, services or items to an enrollee, the coverage of
    18  which is required under section 635.2 and the provider is
    19  enrolled in the Commonwealth's medical assistance program but is
    20  not a network provider with the enrollee's private insurance
    21  plan, the provider shall be reimbursed under the terms and
    22  conditions applicable to the plan's participating providers.
    23  This requirement shall not be subject to any time limitation or
    24  transition period, but shall otherwise be in accord with all
    25  terms applicable to nonparticipating providers under the managed
    26  care continuity of care provisions then in effect.
    27     Section 2.  Section 2121 of the act, added June 17, 1998
    28  (P.L.464, No.68), is amended to read:
    29     Section 2121.  Procedures.--(a)  A managed care plan shall
    30  establish a credentialing process to enroll qualified health
    20070H1150B2326                  - 9 -     

     1  care providers and create an adequate provider network. The
     2  process shall be approved by the department and shall include
     3  written criteria and procedures for initial enrollment, renewal,
     4  restrictions and termination of credentials for health care
     5  providers.
     6     (b)  [The] Except as provided under subsection (b.1), the
     7  department shall establish credentialing standards for managed
     8  care plans. The department may adopt nationally recognized
     9  accrediting standards to establish the credentialing standards
    10  for managed care plans.
    11     (b.1)  Pursuant to section 635.2(g), the Department of Public
    12  Welfare shall establish standards to be utilized by managed care
    13  plans for the credentialing of health care providers providing
    14  care, treatments, interventions, services or items to enrollees
    15  for an autism spectrum disorder as defined under section 635.2.
    16  In addition, the department may require that a managed care plan
    17  grant credentials to any health care provider whom the
    18  Department of Public Welfare determines meets or exceeds the
    19  Department of Public Welfare's credentialing standards.
    20     (b.2)  With respect to autism service providers, a managed     <--
    21  care plan or licensed insurer shall inform credentialing
    22  applicants of a decision within ninety days after the complete
    23  application has been submitted to the managed care plan or
    24  insurer. A managed care plan or insurer shall not require a
    25  health care provider to submit an application for credentialing
    26  as a result of a change of employers if the provider's new
    27  employer is in the managed care plan's service area or network.
    28     (c)  A managed care plan shall submit a report to the
    29  department regarding its credentialing process at least every
    30  two (2) years or as may otherwise be required by the department.
    20070H1150B2326                 - 10 -     

     1     (d)  A managed care plan shall disclose relevant
     2  credentialing criteria and procedures to health care providers
     3  that apply to participate or that are participating in the
     4  plan's provider network. A managed care plan shall also disclose
     5  relevant credentialing criteria and procedures pursuant to a
     6  court order or rule. Any individual providing information during
     7  the credentialing process of a managed care plan shall have the
     8  protections set forth in the act of July 20, 1974 (P.L.564,
     9  No.193), known as the "Peer Review Protection Act."
    10     (e)  No managed care plan shall exclude or terminate a health
    11  care provider from participation in the plan due to any of the
    12  following:
    13     (1)  The health care provider engaged in any of the
    14  activities set forth in section 2113(c).
    15     (2)  The health care provider has a practice that includes a
    16  substantial number of patients with expensive medical
    17  conditions.
    18     (3)  The health care provider objects to the provision of or
    19  refuses to provide a health care service on moral or religious
    20  grounds.
    21     (f)  If a managed care plan denies enrollment or renewal of
    22  credentials to a health care provider, the managed care plan
    23  shall provide the health care provider with written notice of
    24  the decision. The notice shall include a clear rationale for the
    25  decision.
    26     Section 3.  This act shall take effect in 180 days.            <--
    27     SECTION 3.  THIS ACT SHALL TAKE EFFECT AS FOLLOWS:             <--
    28         (1)  THE FOLLOWING PROVISIONS SHALL TAKE EFFECT IN 90
    29     DAYS:
    30             (I)  THE ADDITION OF SECTION 635.2(F) AND (G) OF THE
    20070H1150B2326                 - 11 -     

     1         ACT.
     2             (II)  THE AMENDMENT OF SECTION 2121 OF THE ACT.
     3             (III)  THIS SECTION.
     4         (2)  THE REMAINDER OF THIS ACT SHALL TAKE EFFECT IN 210
     5     DAYS.

















    D25L40MSP/20070H1150B2326       - 12 -

Note/Warning:

Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid. 

ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.

The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t workIn study after repeated study: ABA (conversion therapy) doesn’t work. 

What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.


The ‘cure’ for Autistics not born yet is the prevention of birth. 

The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome. 

This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.


Fact: You can’t cure Autistics from being Autistic.

Fact: You can’t recover an Autistic from being Autistic.

Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.


[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]


Fact: Vaccines Do Not Cause Autism.



Explore Autistic History


One Reply to “Archived | The General Assembly Of Pennsylvania: House Bill No. 1150 Session of 2007 | Circa July 13, 2007 #LegislationWithoutRepresentation #NotAnAutisticAlly”

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