2016 Kentucky Revised Statutes
CHAPTER 304 - INSURANCE CODE
Subtitle 17A - Health Benefit Plans
304.17A-141 Definitions for KRS 304.17A-141, 304.17A-142, and 304.17A-143.

Download as PDF 304.17A-141 Definitions for KRS 304.17A-141, 304.17A-142, and 304.17A-143. As used in this section and KRS 304.17A-142 and 304.17A-143, unless the context requires otherwise: (1) "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 the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior; (2) "Autism services provider" means any licensed person, entity, or group that provides treatment of autism spectrum disorders; (3) "Autism spectrum disorders" means a physical, mental, or cognitive illness or disorder which includes any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders ("DSM") published by the American Psychiatric Association, including Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified; (4) "Diagnosis of autism spectrum disorders" means medically necessary assessments, evaluations, or tests to diagnose whether an individual has any of the autism spectrum disorders, including testing tools which shall be appropriate to the presenting characteristics and age of the individual and be empirically validated for autism spectrum disorders to provide evidence that meets the criteria for autism spectrum disorder in the most recent diagnostic and statistical Manual of Mental Disorders published by the American Psychiatric Association; (5) "Habilitative or rehabilitative care" means professional counseling and guidance services, therapy, and treatment programs, including applied behavior analysis, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual; (6) "Medical care" means services provided by a licensed physician, an advanced registered nurse practitioner, or other licensed health care provider; (7) "Pharmacy care" means medically necessary medications prescribed by a licensed physician or other health-care practitioner with prescribing authority, if covered by the plan, and any medically necessary health-related services to determine the need or effectiveness of the medications; (8) "Psychiatric care" means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices; (9) "Psychological care" means direct or consultative services provided by an individual licensed by the Kentucky Board of Examiners of Psychology or by the appropriate licensing agency in the state in which the individual practices; (10) "Therapeutic care" means services provided by licensed speech therapists, occupational therapists, or physical therapists; and (11) "Treatment for autism spectrum disorders" includes the following care for an individual diagnosed with any of the autism spectrum disorders: (a) (b) (c) (d) (e) (f) (g) Medical care; Habilitative or rehabilitative care; Pharmacy care, if covered by the plan; Psychiatric care; Psychological care; Therapeutic care; and Applied behavior analysis prescribed or ordered by a licensed health or allied health professional. Effective: January 1, 2011 History: Created 2010 Ky. Acts ch. 150, sec. 16, effective January 1, 2011.