The bill amends the Revised Code to enhance insurance and Medicaid coverage for applied behavior analysis (ABA) therapy specifically for 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 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 that third-party payers must reimburse ABA service providers at a minimum of 100% of the Medicaid fee schedule and emphasizes adherence to industry standards of care for ABA treatment.

The legislation 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 and outlines exemptions for licensed professionals. Furthermore, the bill mandates the Department of Medicaid to set payment rates for ABA therapy services for Medicaid enrollees diagnosed with ASD at 100% of the fee-for-service rate for specified procedural codes, while repealing outdated sections of the Revised Code to streamline the legal framework governing ABA practices in Ohio.

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