Summary of 2012 Nebraska Autism Insurance Reform Bill

LB.1129 - Sponsored by Senator Colby Coash

The bill would:

  • require providers of state-regulated insurance plans to provide coverage for the diagnosis and treatment of individuals with autism spectrum disorders up to the age of 21
  • place no cap on the number of visits or dollar amount of benefits, except for coverage of ABA therapy. ABA would be capped at $70,000 per year  up to the age of 9, and $20,000 per year from age 9 to 21
  • require health insurance providers cover all tests, assessments, and evaluations that are necessary to diagnose autism spectrum disorder including neuropsychological evaluations, genetic testing, and other tests required for accurate diagnosis
  • require coverage, following a determination of medical necessity by a licensed physician or psychologist, to include:
  1. habilitative or rehabilitative care necessary to develop,  improve, maintain, and restore to the maximum possible extent an individual’s functioning, including professional counseling and treatment programs such as applied behavior analysis (ABA), developmental approaches, and other behavioral health treatments 
  2. pharmacy care
  3. psychiatric care
  4. psychological care
  5. therapeutic care, which is defined as services provided by licensed or certified speech language pathologists, occupational therapists, or physical therapists
  6. augmentative communication devices and other assistive technology devices
  7. coordination of care services
  8. other care deemed medically necessary and that meets the standards of evidence required for coverage of other prevailing medical or surgical treatments
  • not apply to self-funded insurance plans since those plans are regulated by the federal government under ERISA