SB406 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

SB406 would expand autism treatment coverage in Alabama by requiring certain health plans to cover ASD for all insureds (with defined ABA limits and premium increase controls), require Medicaid ALL Kids to cover ASD, and mandate annual cost reporting.

What This Bill Does

The bill broadens ASD coverage beyond just children to all insured individuals under specific health plans or contracts, with a set maximum annual benefit for applied behavior analysis (ABA) and limits on premium increases caused by the coverage. It requires coverage for a range of ASD-related services (ABA, therapy, and related medical care) and ensures plans cannot deny ASD coverage, while allowing other general exclusions. It also directs Alabama Medicaid and ALL Kids to provide ASD treatment coverage at the same level as private health plans and creates an annual cost report to the Legislature on ASD coverage.

Who It Affects

• Individuals and families enrolled in Alabama health benefit plans that are subject to the bill, who would gain ASD coverage (including ABA) with age-based ABA caps and inflation-adjusted limits.
• Health insurers, the Alabama Department of Insurance, and the Alabama Medicaid program (ALL Kids), which must implement the coverage, manage ABA services, monitor costs, and report annually on ASD-related expenses.

Key Provisions

• Health benefit plans must cover screening, diagnosis, and treatment of Autism Spectrum Disorder for insureds under certain plans; expansion from the existing child-focused requirement to all insureds under those plans/contracts.
• Applied Behavior Analysis (ABA) coverage is included, with annual maximums by age: $40,000 (0-9), $30,000 (10-13), $20,000 (14-18), and $10,000 (19+). The maximums are adjusted annually for inflation starting 2018, by the Insurance Commissioner.
• ABA coverage may be exceeded with prior insurer approval if medically necessary; other than ABA limits, ABA-related costs do not reduce other benefits; services beyond ABA limits may still be covered if approved.
• ABA coverage requires supervision by a Board Certified Behavior Analyst or licensed psychologist, and the treatment plan must include specific elements (diagnosis, treatment type/frequency/duration, goals, plan updates, and provider signature). Insurers may review the plan no more than every six months unless otherwise agreed, with insurer costs for reviews borne by the insurer.
• Plans may not deny or terminate coverage for individuals solely because they have Autism Spectrum Disorder; other general plan exclusions and limitations may still apply.
• Coverage includes related services such as behavioral health treatment, pharmacy, psychiatric, psychological, and therapeutic care for ASD, as defined by the bill.
• Section 27-54A-3 requires the Alabama Medicaid program and ALL Kids to provide ASD treatment coverage and reimbursement in the same manner and levels as health benefit plans.
• The Department of Insurance must file an annual report to the Legislature on ASD coverage costs, including total diagnosed cases, total claims cost, cost per insured per month, and average ABA cost; health plans must provide requested data.
• Effective date: October 1, 2017.

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