2025 -- H 5624

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LC001933

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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, Azzinaro, Fogarty, Cotter, Caldwell, and
Donovan

     Date Introduced: February 26, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 27-20.11-1 and 27-20.11-3 of the General Laws in Chapter 27-20.11

entitled "Autism Spectrum Disorders" are hereby amended to read as follows:

     27-20.11-1. Mandatory coverage for autism spectrum disorders.

     (a) Every group and individual 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, 2012, shall provide coverage for

autism spectrum disorders;. provided, however, the provisions of this chapter shall not apply to

contracts, plans or group policies subject to the Small Employer Health Insurance Availability Act,

chapter 50 of this title, Medical Assistance, chapter 8 of title 40, or subject to the Individual Health

Insurance Coverage Act, chapter 18.5 of this title.

     27-20.11-3. Scope of coverage.

     (a) Benefits under this section chapter 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 chapter 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.

     Every group and individual 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.

     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 would require, for

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

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

reimbursement rate for applied behavior analysis services at equal to, or greater than, the prevailing

integrated state Medicaid rate as established by the executive office of health and human services.

     This act would take effect upon passage.

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