Summary of 2012 Oregon Autism Insurance Reform Bills

House Bill 2214 - Sponsored by State Representatives Peter Buckley (District 5) and Jim Thompson (District 23);Senate Bill 555 - Sponsored by State Senators Chris Edwards (District 7) and Suzanne Bonamici (District 17)

The bills would:

  • require providers of state-regulated insurance plans to provide coverage for the diagnosis and treatment of individuals with autism spectrum disorders who are under the age of 18
  • place no dollar cap on the annual benefit, although the Senate’s version of the bill as amended would limit ABA therapy to children under age 11, up to a maximum of 87 hours per month
  • 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