Assembly Bill 1127 mandates that health insurance policies and the Medical Assistance program provide coverage for both habilitative and rehabilitative speech therapies specifically for the treatment of stuttering. The bill stipulates that this coverage must be offered regardless of whether the stuttering is classified as developmental and must include services delivered in person or via telehealth. Importantly, the coverage cannot be subject to any maximum annual benefit limits, restrictions based on the type of medical condition, or utilization management requirements such as prior authorization. The bill also includes provisions that allow for exceptions if applying these requirements would result in federal cost-sharing obligations for the state.

Additionally, the bill amends existing statutes to clarify that special treatment or care for children in need of protection or services includes habilitative and rehabilitative speech therapies. It creates new definitions for speech therapy and outlines the responsibilities of various health plans, including self-insured governmental plans, to comply with these coverage requirements. The bill aims to ensure that individuals requiring speech therapy for stuttering have access to necessary treatments without undue financial or administrative barriers.

Statutes affected:
Bill Text: 48.02(17m), 48.02, 49.46(2)(b)6.c, 49.46