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 otherwise specified. developmental disorder—not

(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 COL6/24/2021 CH. 18 THE CONTRACT OF INSURANCE 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 COL6/24/2021 CH. 18 THE CONTRACT OF INSURANCE 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 provider means either of the following: disorder service

(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 COL6/24/2021 CH. 18 THE CONTRACT OF INSURANCE 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.