(1) A health benefit plan, as defined in ORS 743.730, must cover for a child enrolled in the plan who is under 18 years of age and who has been diagnosed with a pervasive developmental disorder all medical services, including rehabilitation services, that are medically necessary and are otherwise covered under the plan.
(2) The coverage required under subsection (1) of this section, including rehabilitation services, may be made subject to other provisions of the health benefit plan that apply to covered services, including but not limited to:
(a) Deductibles, copayments or coinsurance;
(b) Prior authorization or utilization review requirements; or
(c) Treatment limitations regarding the number of visits or the duration of treatment.
(3) As used in this section:
(a) “Medically necessary” means in accordance with the definition of medical necessity that is specified in the policy, certificate or contract for the health benefit plan and that applies uniformly to all covered services under the health benefit plan.
(b) “Pervasive developmental disorder” means a neurological condition that includes Asperger’s syndrome, autism, developmental delay, developmental disability or mental retardation.
(c) “Rehabilitation services” means physical therapy, occupational therapy or speech therapy services to restore or improve function.
(4) The provisions of ORS 743A.001 do not apply to this section.
(5) The definition of “pervasive developmental disorder” is not intended to apply to coverage required under ORS 743A.168. [2007 c.872 §2]
Note: Section 8, chapter 872, Oregon Laws 2007, provides:
Sec. 8. Section 2 of this 2007 Act [743A.190] applies to health benefit plan policies issued or renewed on or after the effective date of this 2007 Act [January 1, 2008]. [2007 c.872 §8]
Note: 743A.190 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
Note: Section 2a, chapter 872, Oregon Laws 2007, provides:
Sec. 2a. The Health Resources Commission shall:
(1) Conduct a review of available medical and behavioral health evidence on the treatment of pervasive developmental disorders.
(2) In conducting its review, work with the Public Employees’ Benefit Board, the Health Services Commission, the Department of Human Services and the Department of Education.
(3) Report its findings and recommendations to the Seventy-fifth Legislative Assembly in the manner provided in ORS 192.245. [2007 c.872 §2a]
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Last modified: August 7, 2008