SB164 Alabama 2017 Session

Summary

Primary Sponsor

Tom Whatley

Republican

Session

Regular Session 2017

Title

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

Summary

SB164 would require certain Alabama health benefit plans to cover autism treatment for children nine or younger.

What This Bill Does

It expands required autism coverage to screening, diagnosis, and treatment for insured children age 9 and under in specified group plans. It defines the covered services (including behavioral health treatment, therapy, pharmacy, psychiatric and psychological care) and requires a formal treatment plan with updates. It prohibits denying coverage solely because of an ASD diagnosis and sets a $36,000 per year cap for behavioral therapy (adjusted annually for CPI); it clarifies applicability to group plans and notes self-funded plans may be exempt from some requirements. The act takes effect October 1, 2016 and applies to plans issued in Alabama at renewal.

Who It Affects

• Children in Alabama who are 9 years old or younger and have Autism Spectrum Disorder, along with their families, through group health plans.
• Employers with 51 or more employees offering group health plans in Alabama (and the insurers/plan sponsors administering those plans) who must provide ASD coverage; self-funded plans may be exempt from certain mandates.

Key Provisions

• Amends Sections 10A-20-6.16, 27-21A-23, and 27-54A-2 to require coverage of autism treatment for children age 9 or under in certain health insurance plans.
• Coverage must include screening, diagnosis, and treatment of Autism Spectrum Disorder as prescribed by a treating licensed physician or licensed psychologist, with a formal treatment plan and six-month review updates.
• No denial, cancellation, or non-renewal of coverage solely due to an ASD diagnosis; benefits may be subject to general plan exclusions and limitations.
• Behavioral therapy coverage capped at $36,000 per year, adjustable annually for CPI; other related services (pharmacy, psychiatric, psychological, therapeutic care) are included as part of the treatment.
• Effective date: October 1, 2016; applies to policies delivered in Alabama; self-funded plans administered by employers may be exempt from certain requirements.

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