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 bill outlines that coverage must include various therapeutic services, such as 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, mandating compensation for ABA services at a rate no less than the Medicaid fee schedule.

The legislation also introduces new definitions and provisions related to ABA practice in Ohio, including the definition of "exam-eligible technician" and clarifications on the scope of practice, which excludes psychological testing and long-term counseling. It stipulates that individuals must hold a valid certificate to engage in ABA practice, with exceptions for licensed professionals and supervised individuals. A new section allows exam-eligible technicians to practice ABA under supervision while pursuing certification. Furthermore, the bill mandates the Department of Medicaid to set payment rates for ABA therapy services for Medicaid enrollees with ASD, ensuring alignment with fee-for-service rates for specific procedural codes. The existing sections related to ABA practice are repealed to streamline the regulatory framework for behavior analysts in Ohio, ultimately enhancing access to and regulation of ABA services.

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