The state of Kentucky has a specific autism mandate, which requires that a large group health benefit, individual, and small group market health benefit plans provide coverage for the diagnosis and treatment of autism spectrum disorders (including ABA therapy).
Treatment includes: medical care; habilitative or rehabilitative care; pharmacy care, if covered by the plan; psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); and applied behavior analysis prescribed or ordered by a licensed health or allied health professional. Coverage under this section shall be subject to a maximum annual benefit per covered individual as follows: for individuals between the ages of one (1) through their seventh birthday, the maximum annual benefit shall be $50,000 per individual; for individuals between the ages of seven (7) through 21, the maximum benefit shall be $1,000, per month per individual.
All health benefit plans in the individual and small group market shall provide coverage for pharmacy care, if covered by the plan: psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); applied behavior analysis; habilitative and rehabilitative care. Coverage for autism spectrum disorders shall be subject to $1,000 maximum benefit per month, per covered individual.
*** Please be advised that laws, regulations, and policies may change at any time.***
Ky. Rev. Stat. § 319C (2010 Ky. Acts, Chap. 150; HB 159 of 2010)