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As Introduced
136th
General Assembly
Regular
Session
H. B. No. 453
2025-2026
Representative Lorenz
To
amend sections 1751.84, 3923.84, 4783.01, and 4783.02 and to enact
sections 3901.92 and 4783.40 of the Revised Code
regarding
insurance and Medicaid coverage of applied behavior analysis therapy
for autism treatment and to permit exam-eligible technicians to
engage in the practice of applied behavior analysis.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 1751.84, 3923.84, 4783.01, and 4783.02 be amended and
sections 3901.92 and 4783.40 of the Revised Code be enacted to read
as follows:
Sec.
1751.84.
(A)
Notwithstanding section 3901.71 of the Revised Code, each individual
and group health insuring corporation policy, contract, or agreement
providing basic health care services that is delivered, issued for
delivery, or renewed in this state shall provide coverage for the
screening, diagnosis, and treatment of autism spectrum disorder. A
health insuring corporation shall not terminate an individual's
coverage, or refuse to deliver, execute, issue, amend, adjust, or
renew coverage to an individual solely because the individual is
diagnosed with or has received treatment for an autism spectrum
disorder. Nothing in this section shall be applied to
nongrandfathered plans in the individual and small group markets or
to medicare supplement, accident-only, specified disease, hospital
indemnity, disability income, long-term care, or other limited
benefit hospital insurance policies. Except as otherwise provided in
division (B) of this section, coverage under this section shall not
be subject to dollar limits, deductibles, or coinsurance provisions
that are less favorable to an enrollee than the dollar limits,
deductibles, or coinsurance provisions that apply to substantially
all medical and surgical benefits under the policy, contract, or
agreement.
(B)
Benefits provided under this section shall cover, at minimum, all of
the following:
(1)
For
speech
Speech
and
language therapy or occupational therapy
for
an enrollee under the age of fourteen
that
is performed by a licensed therapist
,
twenty visits per year for each service
;
(2)
For
clinical
Clinical
therapeutic
intervention
for
an enrollee under the age of fourteen
that
is provided by or under the supervision of a professional who is
licensed, certified, or registered by an appropriate agency of this
state to perform such services in accordance with a health treatment
plan
,
twenty hours per week
;
(3)
For
mental
Mental
or
behavioral health outpatient services
for
an enrollee under the age of fourteen
that
are performed by any of the following providing consultation,
assessment, development, or oversight of treatment plans
,
thirty visits per year
:
(a)
A licensed psychologist;
(b)
A licensed physician, including a psychiatrist;
(c)
A clinical nurse specialist or certified nurse practitioner,
including a psychiatric-mental health advanced practice registered
nurse or a clinical nurse specialist or certified nurse practitioner
specializing in pediatric or family health
.
(4)
Adaptive behavior services that are performed by a certified Ohio
behavior analyst under Chapter 4783. of the Revised Code, or an
exam-eligible technician pursuant to section 4783.40 of the Revised
Code
.
(C)(1)
Except as provided in division (C)(2) of this section, this section
shall not be construed as limiting benefits that are otherwise
available to an individual under a policy, contract, or agreement.
(2)
A policy, contract, or agreement shall stipulate that coverage
provided under this section be contingent upon both of the following:
(a)
The covered individual receiving prior authorization for the services
in question;
(b)
The services in question being prescribed or ordered by a
psychologist trained in autism, a developmental pediatrician, or a
clinical nurse specialist or certified nurse practitioner
specializing in pediatric health.
(D)(1)
Except for inpatient services, if an enrollee is receiving treatment
for an autism spectrum disorder, a health insuring corporation may
review the treatment plan annually, unless the health insuring
corporation and the enrollee's treating physician, clinical nurse
specialist, certified nurse practitioner, or psychologist agree that
a more frequent review is necessary.
(2)
Any such agreement as described in division (D)(1) of this section
shall apply only to a particular enrollee being treated for an autism
spectrum disorder and shall not apply to all individuals being
treated for autism spectrum disorder by a physician, clinical nurse
specialist, certified nurse practitioner, or psychologist.
(3)
The health insuring corporation shall cover the cost of obtaining any
review or treatment plan.
(E)
A
health insuring corporation shall use the industry standards of care
set forth in the applied behavior analysis practice guidelines for
the treatment of autism spectrum disorder published by the council of
autism service providers to inform decision-making regarding the use
of applied behavioral analysis as a medically necessary treatment
service.
(F)
This
section shall not be construed as affecting any obligation to provide
services to an enrollee under an individualized family service plan,
an individualized education program, or an individualized service
plan.
(F)
(G)
As used in this section:
(1)
"Applied behavior analysis" means the design,
implementation, and evaluation of environmental modifications, using
behavioral stimuli and consequences, to produce socially significant
improvement in human behavior, including the use of direct
observation, measurement, and functional analysis of the relationship
between environment and behavior.
(2)
"Autism spectrum disorder" means any of the pervasive
developmental disorders or autism spectrum disorder as defined by the
most recent edition of the diagnostic and statistical manual of
mental disorders published by the American psychiatric association
available at the time an individual is first evaluated for suspected
developmental delay.
(3)
"Clinical therapeutic intervention" means therapies
supported by empirical evidence, which include, but are not limited
to, applied behavioral analysis, that satisfy both of the following:
(a)
Are necessary to develop, maintain, or restore, to the maximum extent
practicable, the function of an individual;
(b)
Are provided by or under the supervision of any of the following:
(i)
A certified Ohio behavior analyst as defined in section 4783.01 of
the Revised Code;
(ii)
An individual licensed under Chapter 4732. of the Revised Code to
practice psychology;
(iii)
An individual licensed under Chapter 4757. of the Revised Code to
practice professional counseling, social work, or marriage and family
therapy.
(4)
"Diagnosis of autism spectrum disorder" means medically
necessary assessments, evaluations, or tests to diagnose whether an
individual has an autism spectrum disorder.
(5)
"Pharmacy care" means prescribed medications and any
health-related services considered medically necessary to determine
the need or effectiveness of the medications.
(6)
"Psychiatric care" means direct or consultative services
provided by a psychiatrist or psychiatric-mental health advanced
practice registered nurse who is licensed in the state in which the
psychiatrist or nurse practices.
(7)
"Psychiatric-mental health advanced practice registered nurse"
means an advanced practice registered nurse who is either of the
following:
(a)
A clinical nurse specialist who is certified as a psychiatric-mental
health CNS, or the equivalent of such title, by the American nurses
credentialing center;
(b)
A certified nurse practitioner who is certified as a
psychiatric-mental health NP, or the equivalent of such title, by the
American nurses credentialing center or American academy of nurse
practitioners certification board.
(8)
"Psychological care" means direct or consultative services
provided by a psychologist licensed in the state in which the
psychologist practices.
(9)
"Therapeutic care" means services provided by a speech
therapist, occupational therapist, or physical therapist licensed or
certified in the state in which the person practices.
(10)
"Treatment for autism spectrum disorder" means
evidence-based care and related equipment prescribed or ordered for
an individual diagnosed with an autism spectrum disorder, by a
licensed physician who is a developmental pediatrician, licensed
psychologist trained in autism, clinical nurse specialist or
certified nurse practitioner specializing in pediatric health, or
clinical nurse specialist or certified nurse practitioner trained in
autism who determines the care and related equipment to be medically
necessary, including any of the following:
(a)
Clinical therapeutic intervention;
(b)
Pharmacy care;
(c)
Psychiatric care;
(d)
Psychological care;
(e)
Therapeutic care.
(G)
(H)
If any provision of this section or the application thereof to any
person or circumstances is for any reason held to be invalid, the
remainder of the section and the application of such remainder to
other persons or circumstances shall not be affected thereby.
Sec.
3901.92.
(A)
Third-party payers shall reimburse providers of applied behavior
analysis services for performing adaptive behavior assessment and
treatment procedures at not less than one hundred per cent of the
medicaid fee schedule in effect at the time of service.
(B)
Nothing in this section prohibits a third-party payer from
reimbursing a provider of applied behavior analysis services more
than one hundred per cent of the medicaid fee schedule in effect at
the time of service.
Sec.
3923.84.
(A)
Notwithstanding section 3901.71 of the Revised Code, each individual
and group sickness and accident insurance policy that is delivered,
issued for delivery, or renewed in this state shall provide coverage
for the screening, diagnosis, and treatment of autism spectrum
disorder. A sickness and accident insurer shall not terminate an
individual's coverage, or refuse to deliver, execute, issue, amend,
adjust, or renew coverage to an individual solely because the
individual is diagnosed with or has received treatment for an autism
spectrum disorder. Nothing in this section shall be applied to
nongrandfathered plans in the individual and small group markets or
to medicare supplement, accident-only, specified disease, hospital
indemnity, disability income, long-term care, or other limited
benefit hospital insurance policies. Except as otherwise provided in
division (B) of this section, coverage under this section shall not
be subject to dollar limits, deductibles, or coinsurance provisions
that are less favorable to an insured than the dollar limits,
deductibles, or coinsurance provisions that apply to substantially
all medical and surgical benefits under the policy.
(B)
Benefits provided under this section shall cover, at minimum, all of
the following:
(1)
For
speech
Speech
and
language therapy or occupational therapy
for
an insured under the age of fourteen
that
is performed by a licensed therapist
,
twenty visits per year for each service
;
(2)
For
clinical
Clinical
therapeutic
intervention
for
an insured under the age of fourteen
that
is provided by or under the supervision of a professional who is
licensed, certified, or registered by an appropriate agency of this
state to perform such services in accordance with a health treatment
plan
,
twenty hours per week
;
(3)
For
mental
Mental
or
behavioral health outpatient services
for
an insured under the age of fourteen
that
are performed by any of the following providing consultation,
assessment, development, or oversight of treatment plans
,
thirty visits per year
:
(a)
A licensed psychologist;
(b)
A licensed physician, including a psychiatrist;
(c)
A clinical nurse specialist or certified nurse practitioner,
including a psychiatric-mental health advanced practice registered
nurse or a clinical nurse specialist or certified nurse practitioner
specializing in pediatric or family health
.
(4)
Adaptive behavior services that are performed by a certified Ohio
behavior analyst under Chapter 4783. of the Revised Code, or an
exam-eligible technician pursuant to section 4783.40 of the Revised
Code
.
(C)(1)
Except as provided in division (C)(2) of this section, this section
shall not be construed as limiting benefits that are otherwise
available to an insured under a policy.
(2)
A policy of sickness and accident insurance shall stipulate that
coverage provided under this section be contingent upon both of the
following:
(a)
The covered individual receiving prior authorization for the services
in question;
(b)
The services in question being prescribed or ordered by a
psychologist trained in autism, a developmental pediatrician, or a
clinical nurse specialist or certified nurse practitioner
specializing in pediatric health.
(D)(1)
Except for inpatient services, if an insured is receiving treatment
for an autism spectrum disorder, a sickness and accident insurer may
review the treatment plan annually, unless the insurer and the
insured's treating physician, clinical nurse specialist, certified
nurse practitioner, or psychologist agree that a more frequent review
is necessary.
(2)
Any such agreement as described in division (D)(1) of this section
shall apply only to a particular insured being treated for an autism
spectrum disorder and shall not apply to all individuals being
treated for autism spectrum disorder by a physician, clinical nurse
specialist, certified nurse practitioner, or psychologist.
(3)
The insurer shall cover the cost of obtaining any review or treatment
plan.
(E)
A
sickness and accident insurer shall use the industry standards of
care set forth in the applied behavior analysis practice guidelines
for the treatment of autism spectrum disorder published by the
council of autism service providers to inform decision-making
regarding the use of applied behavioral analysis as a medically
necessary treatment service.
(F)
This
section shall not be construed as affecting any obligation to provide
services to an insured under an individualized family service plan,
an individualized education program, or an individualized service
plan.
(F)
(G)
As used in this section:
(1)
"Applied behavior analysis" means the design,
implementation, and evaluation of environmental modifications, using
behavioral stimuli and consequences, to produce socially significant
improvement in human behavior, including the use of direct
observation, measurement, and functional analysis of the relationship
between environment and behavior.
(2)
"Autism spectrum disorder" means any of the pervasive
developmental disorders or autism spectrum disorder as defined by the
most recent edition of the diagnostic and statistical manual of
mental disorders published by the American psychiatric association
available at the time an individual is first evaluated for suspected
developmental delay.
(3)
"Clinical therapeutic intervention" means therapies
supported by empirical evidence, which include, but are not limited
to, applied behavioral analysis, that satisfy both of the following:
(a)
Are necessary to develop, maintain, or restore, to the maximum extent
practicable, the function of an individual;
(b)
Are provided by or under the supervision of any of the following:
(i)
A certified Ohio behavior analyst as defined in section 4783.01 of
the Revised Code;
(ii)
An individual licensed under Chapter 4732. of the Revised Code to
practice psychology;
(iii)
An individual licensed under Chapter 4757. of the Revised Code to
practice professional counseling, social work, or marriage and family
therapy.
(4)
"Diagnosis of autism spectrum disorder" means medically
necessary assessment, evaluations, or tests to diagnose whether an
individual has an autism spectrum disorder.
(5)
"Industry
standards of care" means the standards of care used in the
applied behavior analysis practice guidelines for the treatment of
autism spectrum disorder published by the council of autism service
providers.
(6)
"Pharmacy
care" means prescribed medications and any health-related
services considered medically necessary to determine the need or
effectiveness of the medications.
(6)
(7)
"Psychiatric care" means direct or consultative services
provided by a psychiatrist or psychiatric-mental health advanced
practice registered nurse who is licensed in the state in which the
psychiatrist or nurse practices.
(7)
(8)
"Psychiatric-mental health advanced practice registered nurse"
means an advanced practice registered nurse who is either of the
following:
(a)
A clinical nurse specialist who is certified as a psychiatric-mental
health CNS, or the equivalent of such title, by the American nurses
credentialing center;
(b)
A certified nurse practitioner who is certified as a
psychiatric-mental health NP, or the equivalent of such title, by the
American nurses credentialing center or American academy of nurse
practitioners certification board.
(8)
(9)
"Psychological care" means direct or consultative services
provided by a psychologist licensed in the state in which the
psychologist practices.
(9)
(10)
"Therapeutic care" means services provided by a speech
therapist, occupational therapist, or physical therapist licensed or
certified in the state in which the person practices.
(10)
(11)
"Treatment for autism spectrum disorder" means
evidence-based care and related equipment prescribed or ordered for
an individual diagnosed with an autism spectrum disorder, by a
licensed physician who is a developmental pediatrician, licensed
psychologist trained in autism, clinical nurse specialist or
certified nurse practitioner specializing in pediatric health, or
clinical nurse specialist or certified nurse practitioner trained in
autism who determines the care and related equipment to be medically
necessary, including any of the following:
(a)
Clinical therapeutic intervention;
(b)
Pharmacy care;
(c)
Psychiatric care;
(d)
Psychological care;
(e)
Therapeutic care.
(G)
(H)
If any provision of this section or the application thereof to any
person or circumstances is for any reason held to be invalid, the
remainder of the section and the application of such remainder to
other persons or circumstances shall not be affected thereby.
Sec.
4783.01.
As
used in this chapter:
(A)
"Certified Ohio behavior analyst" means an individual
holding a current, valid certificate issued under section 4783.04 of
the Revised Code.
(B)(1)
(B)
"Exam-eligible technician" means an individual who has met
the requirements of division (B) of section 4783.40 of the Revised
Code.
(C)(1)
"Practice of applied behavior analysis" means the design,
implementation, and evaluation of instructional and environmental
modifications to produce socially significant improvements in human
behavior and includes the following:
(a)
The empirical identification of functional relations between behavior
and environmental factors, known as functional assessment and
analysis;
(b)
Interventions based on scientific research and the direct observation
and measurement of behavior and the environment;
(c)
Utilization of contextual factors, motivating operations, antecedent
stimuli, positive reinforcement, and other consequences to help
people develop new behaviors, increase or decrease existing
behaviors, and emit behaviors under specific environmental
conditions.
(2)
"Practice of applied behavior analysis" does not include
psychological testing, diagnosis of a mental or physical disorder,
neuropsychology, psychotherapy, cognitive therapy, sex therapy,
psychoanalysis, hypnotherapy, and long-term counseling as treatment
modalities.
Sec.
4783.02.
(A)
Except as otherwise provided in division (B) of this section
and section 4783.40 of the Revised Code
,
no person shall do either of the following:
(1)
Engage in the practice of applied behavior analysis in this state
without holding a certificate issued under section 4783.04 of the
Revised Code;
(2)
Hold the person's self out to be a certified Ohio behavior analyst
unless the person holds a certificate issued under section 4783.04 of
the Revised Code.
(B)
This chapter does not apply to any of the following:
(1)
An individual licensed under Chapter 4732. of the Revised Code to
practice psychology, if the practice of applied behavior analysis
engaged in by the licensed psychologist is within the licensed
psychologist's education, training, and experience;
(2)
An individual licensed under Chapter 4757. of the Revised Code to
practice counseling, social work, or marriage and family therapy, if
the practice of applied behavior analysis engaged in by the licensed
professional counselor, licensed professional clinical counselor,
licensed social worker, or licensed marriage and family therapist is
within the licensee's education, training, and experience;
(3)
An individual acting under the authority and direction of an
individual described in division (B)(1) or (2) of this section;
(4)
An individual practicing applied behavior analysis who is supervised
by a certified Ohio behavior analyst and acting under the authority
and direction of that certified Ohio behavior analyst;
(5)
The delivery of interventions by a direct care provider or family
member to implement components of an applied behavior analysis
treatment plan.
(6)
A behavior analyst who practices with nonhuman or nonpatient clients
or consumers, including applied animal behaviorists and practitioners
of organizational behavior management;
(7)
A licensed professional authorized to practice in this state who, in
the offering or rendering of services, does not represent oneself in
any printed materials or verbally by incorporating the term "applied
behavior analyst," if the services of the licensed professional
are within the scope of practice of the licensing law governing the
licensed professional and the services performed are commensurate
with the licensed professional's education, training, and experience;
(8)
A matriculated graduate student or postdoctoral trainee whose
activities are part of a defined program of study or professional
training;
(9)
An individual employed by the department of developmental
disabilities, a county board of developmental disabilities, or a
council of government consisting of county boards of developmental
disabilities, when the individual is acting in the scope of that
employment;
(10)
A professional employed in a school or other setting that falls under
the regulation of the state board of education when the professional
is acting within the scope of that employment.
(C)
For purposes of division (B)(3) or (4) of this section, an individual
is not subject to this chapter only if the licensed psychologist, the
licensed professional counselor, the licensed professional clinical
counselor, the licensed social worker, the licensed marriage and
family therapist, or the certified Ohio behavior analyst under whose
authority and direction the individual is acting pursuant to division
(B)(3) or (4) of this section signs an attestation stating that the
licensed psychologist, licensed professional counselor, licensed
professional clinical counselor, licensed social worker, licensed
marriage and family therapist, or certified Ohio behavior analyst is
responsible for the care provided by the individual.
Sec.
4783.40.
(A)
Notwithstanding section 4783.02 of the Revised Code, an exam-eligible
technician may engage in the practice of applied behavior analysis in
this state in accordance with this section.
(B)
To be eligible to practice as an exam-eligible technician pursuant to
this section, an individual must be either of the following:
(1)
The individual is in the process of becoming a registered behavior
technician certified by the behavior analyst certification board and
is practicing under the supervision of a certified Ohio behavior
analyst or a board certified assistant behavior analyst holding a
valid certification from the behavior analyst certification board.
(2)
The individual has satisfied all of the following criteria:
(a)
The individual holds a high school diploma or higher degree.
(b)
The individual has completed any equivalent coursework or training
requirements for registered behavior technicians required by the
behavior analyst certification board or its successor organization.
(c)
The individual has passed an initial competency assessment, or
otherwise been found eligible, to sit for a psychometrically valid
examination administered by a nationally accredited credentialing
organization.
(C)
An exam-eligible technician meeting the requirements of this section
may engage in the practice of applied behavior analysis in this state
under the supervision of a certified Ohio behavior analyst for a
period of ninety days after the date the individual meets the
requirements of division (B)(1) of this section. If the individual
does not achieve certification as a certified Ohio behavior analyst
by the end of that ninety-day period, the individual is no longer
eligible to engage in the practice of applied behavior analysis as an
exam-eligible technician.
Section
2.
That
existing sections 1751.84, 3923.84, 4783.01, and 4783.02 of the
Revised Code are hereby repealed.
Section
3.
PAYMENT
RATES FOR ABA THERAPY SERVICES
For
fiscal year 2027, the Department of Medicaid shall establish payment
rates under the care management system established under section
5167.03 of the Revised Code, for applied behavior analysis therapy
services used to treat Medicaid enrollees with a diagnosis of autism
spectrum disorder. These payment rates shall equal one hundred per
cent of the fee-for-service rate for current procedural terminology
codes 97151 through 97158.