The bill amends the Revised Code to improve insurance and Medicaid coverage for applied behavior analysis (ABA) therapy, which is essential for treating autism spectrum disorder (ASD). It requires health insuring corporations and sickness and accident insurers to provide coverage for the screening, diagnosis, and treatment of ASD, ensuring that individuals cannot be denied coverage based solely on their diagnosis. The legislation mandates coverage for various therapeutic services, including speech and language therapy and mental health outpatient services, while introducing provisions for adaptive behavior services performed by certified Ohio behavior analysts or exam-eligible technicians. Additionally, it establishes reimbursement requirements for third-party payers, ensuring compensation for ABA services at a minimum of 100% of the Medicaid fee schedule.

The bill also introduces new definitions and provisions related to ABA practice in Ohio, including the definition of "exam-eligible technician," who can practice under supervision for a limited period. It clarifies that ABA does not encompass certain psychological services, such as diagnosis or psychotherapy, and outlines exemptions for licensed professionals. Furthermore, the Department of Medicaid is mandated to set payment rates for ABA therapy services for Medicaid enrollees diagnosed with ASD at 100% of the fee-for-service rate for specific procedural codes. The bill aims to enhance the regulation and accessibility of ABA services while ensuring that practitioners meet necessary qualifications, and it repeals existing sections of the Revised Code that may conflict with these new provisions.

Statutes affected:
As Introduced: 1751.84, 3923.84, 4783.01, 4783.02