State lawmakers in Nevada are trying to replace their state’s current autism therapy benefits mandate.
Assemblyman James Ohrenschall, D-Las Vegas, and two colleagues have introduced Assembly Bill 369, a bill that could require state-regulated health plans to cover an unlimited amount of medically necessary applied behavioral analysis (ABA) therapy.
Today, Nevada requires carriers to cover ABA therapy — an intensive form of therapy that can cost as much as $100,000 per year in some areas — but lets the carriers limit benefits to $36,000 per year.
Under A.B. 369, the minimum benefit cap for ABA therapy for autism would be enough coverage to pay for “30 hours of treatment per week unless a treatment provides for additional hours of treatment.”
The bill also would require a carrier to include to autism benefits in the basic benefits package, rather than simply making autism benefits an available option; forbid an insurer from denying coverage for an autism treatment on the basis that the treatment was educational in nature; forbid a carrier from asking for copies or reviews of an autism treatment plan more than once a year; and expand access to autism spectrum disorder benefits to include adults.
The bill would take effect July 1.
The bill is under the jurisdiction of the Assembly Commerce and Labor Committee.
The board of the Silver State Health Insurance Exchange — Nevada’s Patient Protection and Affordable Care Act (PPACA) health insurance exchange — has included an analysis of the bill in a health insurance legislative update packet.
PPACA prohibits health insurers from imposing annual or lifetime benefits caps on the dollar value of coverage.
A state can still let an insurer put limits on the number of actuarially equivalent services provided, according to the Silver State exchange legislative analysts.
If Nevada imposes benefits mandates that are stricter than what the state’s basic PPACA “essential health benefits” (EHB) package requires, then the state might have to cover the cost of making the extra benefits available to state residents who qualify for the new PPACA “advance premium tax credit” (APTC), the analysts said.
The APTC is the tool PPACA is set to use to help moderate-income consumers pay for health coverage.
One staff concern about A.B. 369 is that the July 1 effective date “will not give carriers enough time to properly implement the requirement for the 2014 plan year,” the legislative analysts wrote.
Another staff concern is the idea that the state general fund would have to cover the cost of the ABA therapy benefits mandate, the analysts said.