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| 5 | 5 | | 2025 -- H 5253 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC000698 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS |
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| 16 | 16 | | Introduced By: Representatives Spears, McGaw, Cotter, Noret, Fogarty, Boylan, |
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| 17 | 17 | | Speakman, Tanzi, Kislak, and Casey |
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| 18 | 18 | | Date Introduced: January 31, 2025 |
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| 19 | 19 | | Referred To: House Health & Human Services |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Section 27-20.11-3 of the General Laws in Chapter 27-20.11 entitled "Autism 1 |
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| 24 | 24 | | Spectrum Disorders" is hereby amended to read as follows: 2 |
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| 25 | 25 | | 27-20.11-3. Scope of coverage. 3 |
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| 26 | 26 | | (a) Benefits under this section shall include coverage for pharmaceuticals, applied behavior 4 |
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| 27 | 27 | | analysis, physical therapy, speech therapy, psychology, psychiatric and occupational therapy 5 |
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| 28 | 28 | | services for the treatment of autism spectrum disorders, as defined in the most recent edition of the 6 |
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| 29 | 29 | | DSM. Provided, however: 7 |
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| 30 | 30 | | (1) Coverage for physical therapy, speech therapy, and occupational therapy and 8 |
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| 31 | 31 | | psychology, psychiatry, and pharmaceutical services shall be, to the extent such services are a 9 |
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| 32 | 32 | | covered benefit for other diseases and conditions under such policy; and 10 |
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| 33 | 33 | | (2) Applied behavior analysis. 11 |
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| 34 | 34 | | (b) Benefits under this section shall continue until the covered individual reaches age 12 |
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| 35 | 35 | | fifteen (15); provided, however, on or after January 1, 2026, no benefits shall be limited by the age 13 |
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| 36 | 36 | | of the covered individual. 14 |
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| 37 | 37 | | (c) The healthcare benefits outlined in this chapter apply only to services delivered within 15 |
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| 38 | 38 | | the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 16 |
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| 39 | 39 | | coverage for those benefits mandated by this chapter outside of the state of Rhode Island where it 17 |
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| 40 | 40 | | can be established through a pre-authorization process that the required services are not available 18 |
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| 41 | 41 | | in the state of Rhode Island from a provider in the health insurance carrier’s network. 19 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC000698 - Page 2 of 3 |
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| 45 | 45 | | SECTION 2. Chapter 27-20.11 of the General Laws entitled "Autism Spectrum Disorders" 1 |
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| 46 | 46 | | is hereby amended by adding thereto the following section: 2 |
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| 47 | 47 | | 27-20.11-9. Applied behavioral analysis reimbursement rates. 3 |
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| 48 | 48 | | (d) Every group health insurance contract, or every group hospital or medical expense 4 |
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| 49 | 49 | | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 5 |
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| 50 | 50 | | any health insurance carrier, on or after January 1, 2026, shall reimburse certified, applied behavior 6 |
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| 51 | 51 | | analysis providers, who are designated by the executive office of health and human services, for 7 |
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| 52 | 52 | | applied behavior analysis services at rates of reimbursement equal to, or greater than, the prevailing 8 |
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| 53 | 53 | | integrated state Medicaid rate for applied behavior analysis services as established by the executive 9 |
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| 54 | 54 | | office of health and human services. The provisions of this section shall not apply to contracts, 10 |
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| 55 | 55 | | plans, or group policies subject to the small employer health insurance availability act, medical 11 |
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| 56 | 56 | | assistance or subject to the individual health insurance coverage act. 12 |
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| 57 | 57 | | SECTION 3. This act shall take effect upon passage. 13 |
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| 58 | 58 | | ======== |
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| 59 | 59 | | LC000698 |
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| 60 | 60 | | ======== |
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| 61 | 61 | | |
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| 62 | 62 | | |
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| 63 | 63 | | LC000698 - Page 3 of 3 |
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| 64 | 64 | | EXPLANATION |
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| 65 | 65 | | BY THE LEGISLATIVE COUNCIL |
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| 66 | 66 | | OF |
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| 67 | 67 | | A N A C T |
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| 68 | 68 | | RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS |
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| 69 | 69 | | *** |
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| 70 | 70 | | This act would remove the age restriction for benefits coverage and require, for health 1 |
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| 71 | 71 | | insurance policies issued or renewed on or after January 1, 2026, that coverage must include 2 |
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| 72 | 72 | | reimbursement for applied behavior analysis provider services. This act would also set a minimum 3 |
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| 73 | 73 | | reimbursement rate for applied behavior analysis services. 4 |
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| 74 | 74 | | This act would take effect upon passage. 5 |
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| 75 | 75 | | ======== |
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| 76 | 76 | | LC000698 |
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| 77 | 77 | | ======== |
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