autism insurance

Autism Insurance Reform – Navigating HB 463

Good news for families whose insurance has denied coverage of Applied Behavior Analysis (ABA) services in the past.

New state legislation, House Bill 463 (signed into law by Governor Kasich on January 4, 2017), will require coverage for medically necessary treatments of autism, including ABA for individuals under the age of 14 years.

To help you access insurance covered ABA in Ohio, you should know the following:

-HB 463 requires private insurance companies to cover ABA in Ohio starting April 8, 2017

-Autism insurance coverage took years of parental activism and two different legislative bills. The successful bill was spearheaded by Representative Cheryl Grossman of Grove City. The result is House Bill 463, new legislation that includes provisions that require private insurersto provide coverage for autism spectrum disorder. The section of the bill regarding autism coverage originated from House Bill 350, which Rep. Grossman sponsored.

Under the provisions, any health insurance plan is required to provide coverage for the screening, diagnosis and treatment (including ABA services) of autism for individuals up to the age of 14. Coverage cannot be terminated as a result of such a diagnosis.

HB 463 allows a health plan issuer to review an autism spectrum disorder treatment plan on an annual basis. Allows a health plan issuer to review an autism spectrum disorder treatment plan more than once a year if the additional reviews are agreed to by the overseeing physician.

To access ABA services through insurance, parents need:

-A formal diagnosis of autism spectrum disorder

-A Script for ABA Therapy if the diagnosis is either over 1 year old or does not contain a recommendation for ABA Therapy

-Choose an ABA provider who will perform assessment/evaluation that will be used to create a treatment plan that indicates the number of hours of ABA therapy needed (the Treatment Plan must be updated every 6 months and submitted to for re-authorization of services)

If you have questions, contact your insurance company. Parents/guardians are still responsible for co-pays/charges not covered by insurance.