Summary of 2010 Ohio Autism Insurance Reform Bill

House Bill 8 - Sponsored by Representative Ted Celeste (D-24) and Representative Nancy Garland (D-20)
  • Requires private health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder
  • Coverage of treatments will be provided  when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary
  • In order to receive coverage, treatment must be provided by or overseen by a liscensed, certified, or registered provider
  • The bill includes coverage of the following treatments: Diagnosis, Habilitative or rehabilitative care, Pharmacy care, Psychiatric care, Psychological care, Therapeutic care, counseling services, and Applied Behavior Analysis (ABA)
  • Coverage will be subject to a maximum of $36,000 per year
     
  • The bill defines "medically necessary" as a services that is based upon evidence; is prescribed, provided, or ordered by a health care professional licensed or certified under Ohio law to prescribe, provide or order autism-related services in accordance with accepted standards of practice; and will or is reasonably expected to do any of the following:
  1. prevent the onset of an illness, condition, injury, or disability;
  2. reduce or ameliorate the physical, mental, or developmental effects of an illness, condition, injury, or disability; or
  3. assist to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the individual and the functional capacities that are appropriate for individuals of the same age
  • The bill applies only to fully unded individual and group health plans and multi employer welfare arrangements governed by state law 
  • The insurer can request to a review of treatment every six months

If enacted, the bill will go into effect in January 2011