Removes the age restriction for benefits coverage and requires, for health insurance policies issued or renewed on or after January 1, 2026, that coverage must include reimbursement for applied behavior analysis provider services.
Impact
The bill also seeks to establish minimum reimbursement rates for applied behavior analysis (ABA) services, mandating that health insurance carriers reimburse certified providers at rates equal to or greater than the prevailing state Medicaid rate for such services. The introduction of this provision aims to ensure that providers are adequately compensated, potentially increasing the availability and quality of ABA services for individuals with autism in Rhode Island.
Summary
House Bill 5253 aims to amend existing insurance laws relating to the treatment of autism spectrum disorders. The key change proposed by this bill is the removal of the age limit (currently set at 15 years) for coverage under health insurance plans for autism treatment. This is significant as it expands the scope of services available to individuals with autism, ensuring that they can receive necessary care and therapies beyond the age of 15, facilitating continued support during their developmental years into adulthood.
Contention
While the bill is intended to enhance and expand coverage for autism treatment, particularly for applied behavior analysis, it may incite debate regarding the financial implications for health insurance providers and how this will impact overall insurance premiums. Skeptics may argue that increased reimbursement rates could lead to increased costs for insurers, which could subsequently be passed on to consumers in the form of higher premiums. However, supporters contend that enhancing coverage, especially for critical therapies like ABA, will ultimately benefit not only individuals with autism but also society at large by promoting better health outcomes and reducing long-term care costs.
Requires that any insurance contract issued, amended or renewed on or after January 1, 2025, that provides hospital, medical or surgical coverage shall provide coverage for medically necessary treatment of mental health or substance use disorders.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Requires that the department of human services and the department of behavioral healthcare, developmental disabilities and hospitals provide forecasted costs reflecting the recommended rate review on a monthly basis.
Requires that the department of human services and the department of behavioral healthcare, developmental disabilities and hospitals provide forecasted costs reflecting the recommended rate review on a monthly basis.
Requires insurance coverage for all community health workers' services to include health and promotion coaching, health education and training, health system navigation and resource coordination services, care planning and follow-up care recommendations.
Requires insurance coverage for all community health workers' services to include health and promotion coaching, health education and training, health system navigation and resource coordination services, care planning and follow-up care recommendations.
Requires insurance coverage for all services provided by a pharmacist provided coverage of such services would have been covered if provided by a physician, advanced practice nurse, or physician assistant.