2025 -- H 5253

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LC000698

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS

     Introduced By: Representatives Spears, McGaw, Cotter, Noret, Fogarty, Boylan,
Speakman, Tanzi, Kislak, and Casey

     Date Introduced: January 31, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-20.11-3 of the General Laws in Chapter 27-20.11 entitled "Autism

Spectrum Disorders" is hereby amended to read as follows:

     27-20.11-3. Scope of coverage.

     (a) Benefits under this section shall include coverage for pharmaceuticals, applied behavior

analysis, physical therapy, speech therapy, psychology, psychiatric and occupational therapy

services for the treatment of autism spectrum disorders, as defined in the most recent edition of the

DSM. Provided, however:

     (1) Coverage for physical therapy, speech therapy, and occupational therapy and

psychology, psychiatry, and pharmaceutical services shall be, to the extent such services are a

covered benefit for other diseases and conditions under such policy; and

     (2) Applied behavior analysis.

     (b) Benefits under this section shall continue until the covered individual reaches age

fifteen (15); provided, however, on or after January 1, 2026, no benefits shall be limited by the age

of the covered individual.

     (c) The healthcare benefits outlined in this chapter apply only to services delivered within

the state of Rhode Island; provided, that all health insurance carriers shall be required to provide

coverage for those benefits mandated by this chapter outside of the state of Rhode Island where it

can be established through a pre-authorization process that the required services are not available

in the state of Rhode Island from a provider in the health insurance carrier’s network.

     SECTION 2. Chapter 27-20.11 of the General Laws entitled "Autism Spectrum Disorders"

is hereby amended by adding thereto the following section:

     27-20.11-9. Applied behavioral analysis reimbursement rates.

     (d) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2026, shall reimburse certified, applied behavior

analysis providers, who are designated by the executive office of health and human services, for

applied behavior analysis services at rates of reimbursement equal to, or greater than, the prevailing

integrated state Medicaid rate for applied behavior analysis services as established by the executive

office of health and human services. The provisions of this section shall not apply to contracts,

plans, or group policies subject to the small employer health insurance availability act, medical

assistance or subject to the individual health insurance coverage act.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- AUTISM SPECTRUM DISORDERS

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     This act would remove the age restriction for benefits coverage and require, for health

insurance policies issued or renewed on or after January 1, 2026, that coverage must include

reimbursement for applied behavior analysis provider services. This act would also set a minimum

reimbursement rate for applied behavior analysis services.

     This act would take effect upon passage.

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