Coverage for autism spectrum disorders approved

Senators passed a bill April 17 that requires insurance coverage for children with autism spectrum disorders.

LB254, originally introduced by York Sen. Greg Adams, would have renamed the Nebraska Educational Television Commission.

A select file amendment struck the bill’s original language and instead incorporated provisions of LB505, originally introduced by Lincoln Sen. Colby Coash. The amended bill requires insurance coverage for applied behavior analysis and other autism spectrum disorder treatments.

The measure requires that insurance plans in Nebraska provide coverage for autism screening, diagnosis and treatment provided by a board-certified behavior analyst or licensed psychologist. Disease-specific and self-funded employee plans are exempt from the bill’s provisions.

Required annual coverage amounts are limited to 25 hours per week until the insured person is 21 years old. An insurer has the right to request a review of an individual’s treatment every six months.

The measure does not apply to qualified health plans in individual and small group markets sold through and outside the state’s health insurance exchange that are required to include essential health benefits under the federal Affordable Care Act.

The bill also incorporates provisions of LB397, originally introduced by Lincoln Sen. Danielle Conrad, which requires the state Department of Health and Human Services to establish a two-year program to provide amino-acid based elemental formulas for the diagnosis and treatment of food allergies, food protein induced enterocolitis syndrome, eosinophilic disorders and short-bowel syndrome.

The program provides funding when an ordering physician issues a written order stating that amino-based elemental formula is necessary for the treatment of a disease or disorder. A $250,000 appropriation funds the pilot program, which provides up to 50 percent of out-of-pocket costs for treatment, not to exceed $12,000 per child in a 12-month period.

Additionally, the bill incorporates provisions of LB883, originally introduced by Omaha Sen. Jeremy Nordquist. It repeals the Dec. 31, 2015, termination date for a requirement that individual and group health policies, certificates and contracts and self-funded employee benefit plans—to the extent not preempted by federal law—provide coverage for orally administered anticancer medication on a basis no less favorable than intravenously administered or injected anticancer medications.

Senators passed the bill on a 48-0 vote.