Plain English Breakdown
The official source material does not specify all the conditions or limitations for when insurance plans must cover behavior analysis services at the specified rate. Therefore, additional details were omitted to ensure accuracy based on available information.
Insurance Coverage for Behavior Analysis Services
This bill requires state employee health plans and private accident and sickness insurance policies to cover applied behavior analysis services at a rate of not less than 110% of the Medicaid reimbursement rate.
What This Bill Does
- Requires state employee health plans to reimburse providers for behavior analysis services at a rate of not less than 110% of the Medicaid reimbursement rate under certain circumstances.
- Requires private accident and sickness insurance policies to cover behavior analysis services at a rate of not less than 110% of the Medicaid reimbursement rate under certain circumstances.
- Requires health maintenance organization contracts to reimburse providers for behavior analysis services at a rate of not less than 110% of the Medicaid reimbursement rate under certain circumstances.
Who It Names or Affects
- People with state employee health plans
- Individuals covered by private accident and sickness insurance policies
- Enrollees in health maintenance organizations (HMOs)
Terms To Know
- Behavior Analysis Services
- Services provided to help individuals change behaviors through understanding and modifying their environment.
- Medicaid Reimbursement Rate
- The amount of money Medicaid pays for specific services, which this bill uses as a baseline for insurance coverage rates.
Limits and Unknowns
- It is not clear when the effective date will be set.
- The bill does not specify all the circumstances under which these requirements apply.