KY Autism Insurance Reform

Governor Beshear signs House Bill 159The House Bill 159, also known as the Autism Insurance Reform Bill, was signed into law on April 14, 2010 by Kentucky’s Governor Steve Beshear. Kentucky joins sixteen other States to enact the new law.
The following is a summary of House Bill 159 posted on the website Autism Votes
Summary of Kentucky Autism Insurance Reform Law:
Sponsored by State Representative Jeff Greer
  • Would require health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders
  • HB 159 stipulates that coverage for individuals between the ages of one and six will be subject to a maximum annual benefit of $50,000 and that coverage for individuals between the ages of seven and twenty-one will be subject to a maximum monthly benefit of $1,000.  SB 13 has no cap on age or annual/monthly benefit.
  • Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary
  • Under these bills, health insurance companies would be required to provide coverage of the following:
    • Diagnosis of an autism spectrum disorder – meaning medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing, or other testing to determine whether an individual has one or more autism spectrum disorders
    • Habilitative or rehabilitative care – meaning professional counseling, guidance, services, and treatment programs, including applied behavior analysis (ABA) and other behavioral health treatments, that are necessary to develop, maintain, and restore to the maximum possible extent an individuals functioning
    • Pharmacy care
    • Psychiatric care
    • Psychological care
    • Therapeutic care – meaning services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists, or social workers
  • HB 159 creates a licensing board for behavior analysts and requires licensure for BCBAs and BCaBAs
  • The bills do not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan
  • The bill applies only to state regulated insurance plans. It does not apply to self-funded insurance plans as these plans are regulated by the federal government under ERISA law
  • The bills would apply to state regulated health insurance plans that are delivered, executed, issued, amended, adjusted, or renewed within Kentucky, or outside of the state if insuring Kentucky residents