HB284 Alabama 2017 Session

Summary

Primary Sponsor

Jim Patterson

Republican

Session

Regular Session 2017

Title

Health benefit plans, autism, coverage of autism spectrum disorder under certain conditions, Secs. 10A-20-6.16, 27-21A-23, 27-54A-2 am'd.

Summary

HB284 requires health benefit plans in Alabama to cover Autism Spectrum Disorder treatment, including applied behavior analysis, with age-based limits and treatment-plan requirements, and extends similar coverage to Medicaid/ALL Kids.

What This Bill Does

It mandates coverage for screening, diagnosis, and treatment of autism for insured individuals, including behavioral health services such as applied behavior analysis (ABA). ABA has annual maximums by age (0-9: $40,000; 10-13: $30,000; 14-18: $20,000; 19+: $10,000) with possible exceptions if the insurer approves additional treatment. Coverage may not be denied solely because of an autism diagnosis, and a detailed treatment plan must be provided, updated at least every six months with insurer costs covering treatment-plan reviews. Beginning December 31, 2018, Alabama Medicaid and ALL Kids must provide the same coverage and reimbursement levels as health benefit plans. The act also applies to self-funded plans only to the extent noted in the law.

Who It Affects

• Individuals diagnosed with Autism Spectrum Disorder and their families who have health insurance or benefits through group plans, who will gain mandatory ASD screening, diagnosis, and treatment coverage (including ABA).
• Health benefit plans, insurers, employers offering group health coverage, and the Alabama Medicaid Agency/ALL Kids program, which must implement the coverage rules, manage treatment plans, and coordinate with providers (with certain exemptions for self-funded plans).

Key Provisions

• Requires health benefit plans to cover screening, diagnosis, and treatment of Autism Spectrum Disorder, including behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care.
• Applies annual ABA coverage limits by age: $40,000/year for ages 0-9, $30,000/year for ages 10-13, $20,000/year for ages 14-18, and $10,000/year for ages 19+, with possible exception if medically necessary and approved by the insurer.
• Prohibits denying or terminating coverage for ASD-related treatment based solely on an autism diagnosis; allows other standard plan exclusions and limitations to apply.
• Requires a treatment plan with specific elements (diagnosis, treatment type, frequency/duration, goals, updates, and provider signatures); insurer can request updates no more than every six months, at insurer cost.
• Starting December 31, 2018, Alabama Medicaid and ALL Kids must provide ASD treatment coverage and reimbursement at the same levels as health benefit plans.
• Effective date of the act is October 1, 2017; self-funded plans are subject to certain provisions only as specified in the law.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health