HB 2962 Summary

• Health benefit plans and Oklahoma Employees Health Insurance Plan must cover screening, diagnosis, and treatment of autism spectrum disorders for individuals under age 9, or for at least 6 years if diagnosis occurs after age 3, provided the individual shows sufficient progress.

• Applied behavior analysis coverage is subject to a maximum of 25 hours per week and $25,000 per year, with annual inflation adjustments by the Oklahoma Insurance Commissioner based on the Medical Care Component of the Consumer Price Index.

• Insurers cannot terminate or refuse coverage based solely on an autism spectrum disorder diagnosis and cannot impose visit limits or less favorable dollar limits, deductibles, or coinsurance compared to other medical and surgical benefits.

• Insurers have the right to review treatment plans annually (except inpatient services) and must bear the cost of obtaining such reviews; insurers may seek more frequent reviews only with treating physician or psychologist agreement.

• The Oklahoma Health Care Authority must examine feasibility of a Medicaid state plan amendment for applied behavior analysis treatment and submit a report by December 31, 2016; effective date is November 1, 2016.