Today, the South Dakota Department of Labor and Regulation noted in a memo that there is a proposal that has been filed which would potentially add coverage for applied behavior analysis (or ABA therapy) for children diagnosed with Autism Spectrum Disorder within certain limits for individual and small group ACA compliant health plans.
SD Proposed EHB Benchmark Summary 04292019 by Pat Powers on Scribd
Read it here on the state’s website. (Main page for document)
This would represent an expansion of the state’s very limited Autism coverage that was enacted a few years back. This proposal is a fairly technical way to go about the inclusion of the coverage, but had been identified a few years back (by the group I was involved in) as one way coverage could be extended to more families. As noted in the memo:
The Affordable Care Act (ACA) established a requirement for all non-grandfathered plans in the individual and small group market to cover essential health benefits (EHB) in 10 benefit categories.
Each state’s designated EHB benchmark plan serves as a baseline for the minimum scope of benefits that individual and small group ACA compliant health plans must cover at equal or greater value.
If passed, revising the minimum level of coverage to included ABA therapy would have the effect of expanding the present number of policies covering the therapy to include a limited number of treatments as part of the minimum scope of benefits for insurance policies in the individual and small group markets.
For families of children with Autism, this proposal coming from the Noem administration is huge, and would help fill the gap that many families were experiencing, and seeking relief from the state legislature for this past session.
According to the Division of Insurance, comments on the proposed EHB Benchmark plan will be accepted as follows:
Proposed EHB Benchmark Design for Plan Year 2021
Director Larry Deiter invites the public to comment on the proposed Essential Health Benefits (EHB) benchmark design for plan year 2021. Public comments will be accepted from April 29, 2019 to May 15, 2019.
- Summary of Proposed EHB Benchmark Design for Plan Year 2021
- Current EHB Benchmark Information
- Provide Public Comment – click here to submit comment online
Written submissions can be mailed to the Division of Insurance at 124 S. Euclid Avenue, 2nd Floor, Pierre, SD 57501 or faxed to 605.773.5369
Stay tuned for more on this.
It always starts small…
Are you being ignorant or sarcastic? They’re amending the minimum level of benefits and content of policies. That requirement has long been there, and every state sets that with the federal government.
What about the children who need help now? The children who were receiving therapy and doing GREAT but have went down hill without it, what about them. This is huge for people with Autism! But it is coming to late for a group of children who need it now. Please think of them!
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