Kansas State-Regulated Insurance Coverage

Kansas requires meaningful coverage for autism under state regulated plans.

On January 1, 2014, HB 2744 was passed adding coverage to large group plans, small grandfathered plans and individual grandfathered plans.

To which plan types does the STATE autism insurance law apply?

  • Individual Grandfathered Plans - YES
  • Individual Non-Grandfathered Plans - NO
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Grandfathered Plans - YES
  • Fully Insured Small Group Non-Grandfathered Plans - NO

What services are covered by law?

  • Diagnosis
  • Applied Behavior Analysis
  • Services when required by a licensed physician, licensed psychologist or licensed specialist clinical social worker but otherwise shall be limited to the care, services and related equipment prescribed or ordered by a licensed physician, licensed psychologist or licensed specialist clinical social worker

Age and Dollar Caps on ABA Coverage

Coverage is limited to individuals under 12 years of age. ABA is also limited to 1,300 hours per year for 4 years, beginning on either the date of diagnosis or January 1, 2015 (whichever is the later date). For an individual diagnosed before 5 years of age, ABA is limited to 520 hours per year until age 12. There are no treatment limits on other covered services.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.  This includes quantitative treatment limits like age and dollar caps.  Learn more here.

Where can I find more details about the Kansas autism insurance law?

A copy of HB 2744 as enrolled can be found here.

If you have additional questions, please email advocacy@autismspeaks.org.

 

Last Updated: December 2019

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