State Order Directs Kentucky Insurers to Start Covering ABA Services

LEXINGTON (May 10, 2012) -- Autism Speaks praised the Kentucky Department of Insurance for issuing an advisory opinion directing health insurers to start covering services provided by supervised ABA providers, finding that autism treatment would be "severely compromised" without their services.

Kentucky law explicitly exempts persons who provide Applied Behavior Analysis (ABA) under the supervision of a licensed professional from themselves having to gain certification, according to the opinion, signed by Insurance Commissioner Sharon Clark. Their services should therefore be reimbursed under Kentucky's 2010 autism insurance reform law, the department concluded.

“This opinion eliminates a significant and unnecessary hurdle that has blocked many Kentucky families from obtaining appropriate levels of ABA therapy for their children with autism,” said Lorri Unumb, Esq, vice president for state government affairs. “The Kentucky Department of Insurance correctly interpreted the text of the state’s 2010 autism insurance reform law and the will of the Legislature in directing health insurers to start covering these services.”

The opinion noted that ABA therapy requires a functional assessment and behavior plan developed by a Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA). The direct services ultimately provided under the treatment plan, however, are typically rendered by "supervisees" – the front-line personnel who carry out the intervention.

"Clearly, Kentucky's statutes pertaining to ABA and the treatment of autism spectrum disorders contemplate the active involvement of supervisees, provided that they are acting under the extended authority and direction of a BCBA or a BCaBA," the opinion states.

"To exclude coverage for supervisees undermines the intent of (state law) which is to mandate coverage for the diagnosis and treatment of autism spectrum disorders," the order said. "Without the direct services provided by supervisees, the treatment of autism is severely compromised."