As Introduced

136th General Assembly

Regular Session H. B. No. 453

2025-2026

To amend sections 1751.84, 3923.84, 4783.01, and 4783.02 and to enact sections 3901.92 and 4783.40 of the Revised Code regarding insurance and Medicaid coverage of applied behavior analysis therapy for autism treatment and to permit exam-eligible technicians to engage in the practice of applied behavior analysis.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1751.84, 3923.84, 4783.01, and 4783.02 be amended and sections 3901.92 and 4783.40 of the Revised Code be enacted to read as follows:

Sec. 1751.84. (A) Notwithstanding section 3901.71 of the Revised Code, each individual and group health insuring corporation policy, contract, or agreement providing basic health care services that is delivered, issued for delivery, or renewed in this state shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. A health insuring corporation shall not terminate an individual's coverage, or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder. Nothing in this section shall be applied to nongrandfathered plans in the individual and small group markets or to medicare supplement, accident-only, specified disease, hospital indemnity, disability income, long-term care, or other limited benefit hospital insurance policies. Except as otherwise provided in division (B) of this section, coverage under this section shall not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an enrollee than the dollar limits, deductibles, or coinsurance provisions that apply to substantially all medical and surgical benefits under the policy, contract, or agreement.

(B) Benefits provided under this section shall cover, at minimum, all of the following:

(1) ~~For speech~~ Speech and language therapy or occupational therapy ~~for an enrollee under the age of fourteen~~ that is performed by a licensed therapist~~, twenty visits per year for each service~~;

(2) ~~For clinical~~ Clinical therapeutic intervention ~~for an enrollee under the age of fourteen~~ that is provided by or under the supervision of a professional who is licensed, certified, or registered by an appropriate agency of this state to perform such services in accordance with a health treatment plan~~, twenty hours per week~~;

(3) ~~For mental~~ Mental or behavioral health outpatient services ~~for an enrollee under the age of fourteen~~ that are performed by any of the following providing consultation, assessment, development, or oversight of treatment plans~~, thirty visits per year~~:

(a) A licensed psychologist;

(b) A licensed physician, including a psychiatrist;

(c) A clinical nurse specialist or certified nurse practitioner, including a psychiatric-mental health advanced practice registered nurse or a clinical nurse specialist or certified nurse practitioner specializing in pediatric or family health.

(4) Adaptive behavior services that are performed by a certified Ohio behavior analyst under Chapter 4783. of the Revised Code, or an exam-eligible technician pursuant to section 4783.40 of the Revised Code.

(C)(1) Except as provided in division (C)(2) of this section, this section shall not be construed as limiting benefits that are otherwise available to an individual under a policy, contract, or agreement.

(2) A policy, contract, or agreement shall stipulate that coverage provided under this section be contingent upon both of the following:

(a) The covered individual receiving prior authorization for the services in question;

(b) The services in question being prescribed or ordered by a psychologist trained in autism, a developmental pediatrician, or a clinical nurse specialist or certified nurse practitioner specializing in pediatric health.

(D)(1) Except for inpatient services, if an enrollee is receiving treatment for an autism spectrum disorder, a health insuring corporation may review the treatment plan annually, unless the health insuring corporation and the enrollee's treating physician, clinical nurse specialist, certified nurse practitioner, or psychologist agree that a more frequent review is necessary.

(2) Any such agreement as described in division (D)(1) of this section shall apply only to a particular enrollee being treated for an autism spectrum disorder and shall not apply to all individuals being treated for autism spectrum disorder by a physician, clinical nurse specialist, certified nurse practitioner, or psychologist.

(3) The health insuring corporation shall cover the cost of obtaining any review or treatment plan.

(E) A health insuring corporation shall use the industry standards of care set forth in the applied behavior analysis practice guidelines for the treatment of autism spectrum disorder published by the council of autism service providers to inform decision-making regarding the use of applied behavioral analysis as a medically necessary treatment service.

(F) This section shall not be construed as affecting any obligation to provide services to an enrollee under an individualized family service plan, an individualized education program, or an individualized service plan.

~~(F)~~(G) As used in this section:

(1) "Applied behavior analysis" means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.

(2) "Autism spectrum disorder" means any of the pervasive developmental disorders or autism spectrum disorder as defined by the most recent edition of the diagnostic and statistical manual of mental disorders published by the American psychiatric association available at the time an individual is first evaluated for suspected developmental delay.

(3) "Clinical therapeutic intervention" means therapies supported by empirical evidence, which include, but are not limited to, applied behavioral analysis, that satisfy both of the following:

(a) Are necessary to develop, maintain, or restore, to the maximum extent practicable, the function of an individual;

(b) Are provided by or under the supervision of any of the following:

(i) A certified Ohio behavior analyst as defined in section 4783.01 of the Revised Code;

(ii) An individual licensed under Chapter 4732. of the Revised Code to practice psychology;

(iii) An individual licensed under Chapter 4757. of the Revised Code to practice professional counseling, social work, or marriage and family therapy.

(4) "Diagnosis of autism spectrum disorder" means medically necessary assessments, evaluations, or tests to diagnose whether an individual has an autism spectrum disorder.

(5) "Pharmacy care" means prescribed medications and any health-related services considered medically necessary to determine the need or effectiveness of the medications.

(6) "Psychiatric care" means direct or consultative services provided by a psychiatrist or psychiatric-mental health advanced practice registered nurse who is licensed in the state in which the psychiatrist or nurse practices.

(7) "Psychiatric-mental health advanced practice registered nurse" means an advanced practice registered nurse who is either of the following:

(a) A clinical nurse specialist who is certified as a psychiatric-mental health CNS, or the equivalent of such title, by the American nurses credentialing center;

(b) A certified nurse practitioner who is certified as a psychiatric-mental health NP, or the equivalent of such title, by the American nurses credentialing center or American academy of nurse practitioners certification board.

(8) "Psychological care" means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

(9) "Therapeutic care" means services provided by a speech therapist, occupational therapist, or physical therapist licensed or certified in the state in which the person practices.

(10) "Treatment for autism spectrum disorder" means evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder, by a licensed physician who is a developmental pediatrician, licensed psychologist trained in autism, clinical nurse specialist or certified nurse practitioner specializing in pediatric health, or clinical nurse specialist or certified nurse practitioner trained in autism who determines the care and related equipment to be medically necessary, including any of the following:

(a) Clinical therapeutic intervention;

(b) Pharmacy care;

(d) Psychological care;

(e) Therapeutic care.

~~(G)~~(H) If any provision of this section or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the section and the application of such remainder to other persons or circumstances shall not be affected thereby.

Sec. 3901.92. (A) Third-party payers shall reimburse providers of applied behavior analysis services for performing adaptive behavior assessment and treatment procedures at not less than one hundred per cent of the medicaid fee schedule in effect at the time of service.

(B) Nothing in this section prohibits a third-party payer from reimbursing a provider of applied behavior analysis services more than one hundred per cent of the medicaid fee schedule in effect at the time of service.

Sec. 3923.84. (A) Notwithstanding section 3901.71 of the Revised Code, each individual and group sickness and accident insurance policy that is delivered, issued for delivery, or renewed in this state shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. A sickness and accident insurer shall not terminate an individual's coverage, or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder. Nothing in this section shall be applied to nongrandfathered plans in the individual and small group markets or to medicare supplement, accident-only, specified disease, hospital indemnity, disability income, long-term care, or other limited benefit hospital insurance policies. Except as otherwise provided in division (B) of this section, coverage under this section shall not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to substantially all medical and surgical benefits under the policy.

(B) Benefits provided under this section shall cover, at minimum, all of the following:

(1) ~~For speech~~ Speech and language therapy or occupational therapy ~~for an insured under the age of fourteen~~ that is performed by a licensed therapist~~, twenty visits per year for each service~~;

(2) ~~For clinical~~ Clinical therapeutic intervention ~~for an insured under the age of fourteen~~ that is provided by or under the supervision of a professional who is licensed, certified, or registered by an appropriate agency of this state to perform such services in accordance with a health treatment plan~~, twenty hours per week~~;

(3) ~~For mental~~ Mental or behavioral health outpatient services ~~for an insured under the age of fourteen~~ that are performed by any of the following providing consultation, assessment, development, or oversight of treatment plans~~, thirty visits per year~~:

(a) A licensed psychologist;

(b) A licensed physician, including a psychiatrist;

(C)(1) Except as provided in division (C)(2) of this section, this section shall not be construed as limiting benefits that are otherwise available to an insured under a policy.

(2) A policy of sickness and accident insurance shall stipulate that coverage provided under this section be contingent upon both of the following:

(a) The covered individual receiving prior authorization for the services in question;

(D)(1) Except for inpatient services, if an insured is receiving treatment for an autism spectrum disorder, a sickness and accident insurer may review the treatment plan annually, unless the insurer and the insured's treating physician, clinical nurse specialist, certified nurse practitioner, or psychologist agree that a more frequent review is necessary.

(2) Any such agreement as described in division (D)(1) of this section shall apply only to a particular insured being treated for an autism spectrum disorder and shall not apply to all individuals being treated for autism spectrum disorder by a physician, clinical nurse specialist, certified nurse practitioner, or psychologist.

(3) The insurer shall cover the cost of obtaining any review or treatment plan.

(E) A sickness and accident insurer shall use the industry standards of care set forth in the applied behavior analysis practice guidelines for the treatment of autism spectrum disorder published by the council of autism service providers to inform decision-making regarding the use of applied behavioral analysis as a medically necessary treatment service.

(F) This section shall not be construed as affecting any obligation to provide services to an insured under an individualized family service plan, an individualized education program, or an individualized service plan.

~~(F)~~(G) As used in this section:

(3) "Clinical therapeutic intervention" means therapies supported by empirical evidence, which include, but are not limited to, applied behavioral analysis, that satisfy both of the following:

(a) Are necessary to develop, maintain, or restore, to the maximum extent practicable, the function of an individual;

(b) Are provided by or under the supervision of any of the following:

(i) A certified Ohio behavior analyst as defined in section 4783.01 of the Revised Code;

(ii) An individual licensed under Chapter 4732. of the Revised Code to practice psychology;

(iii) An individual licensed under Chapter 4757. of the Revised Code to practice professional counseling, social work, or marriage and family therapy.

(4) "Diagnosis of autism spectrum disorder" means medically necessary assessment, evaluations, or tests to diagnose whether an individual has an autism spectrum disorder.

(5) "Industry standards of care" means the standards of care used in the applied behavior analysis practice guidelines for the treatment of autism spectrum disorder published by the council of autism service providers.

(6) "Pharmacy care" means prescribed medications and any health-related services considered medically necessary to determine the need or effectiveness of the medications.

~~(6)~~(7) "Psychiatric care" means direct or consultative services provided by a psychiatrist or psychiatric-mental health advanced practice registered nurse who is licensed in the state in which the psychiatrist or nurse practices.

~~(7)~~(8) "Psychiatric-mental health advanced practice registered nurse" means an advanced practice registered nurse who is either of the following:

(a) A clinical nurse specialist who is certified as a psychiatric-mental health CNS, or the equivalent of such title, by the American nurses credentialing center;

~~(8)~~(9) "Psychological care" means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

~~(9)~~(10) "Therapeutic care" means services provided by a speech therapist, occupational therapist, or physical therapist licensed or certified in the state in which the person practices.

~~(10)~~(11) "Treatment for autism spectrum disorder" means evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder, by a licensed physician who is a developmental pediatrician, licensed psychologist trained in autism, clinical nurse specialist or certified nurse practitioner specializing in pediatric health, or clinical nurse specialist or certified nurse practitioner trained in autism who determines the care and related equipment to be medically necessary, including any of the following:

(a) Clinical therapeutic intervention;

(b) Pharmacy care;

(d) Psychological care;

(e) Therapeutic care.

Sec. 4783.01. As used in this chapter:

(A) "Certified Ohio behavior analyst" means an individual holding a current, valid certificate issued under section 4783.04 of the Revised Code.

~~(B)(1)~~(B) "Exam-eligible technician" means an individual who has met the requirements of division (B) of section 4783.40 of the Revised Code.

(C)(1) "Practice of applied behavior analysis" means the design, implementation, and evaluation of instructional and environmental modifications to produce socially significant improvements in human behavior and includes the following:

(a) The empirical identification of functional relations between behavior and environmental factors, known as functional assessment and analysis;

(b) Interventions based on scientific research and the direct observation and measurement of behavior and the environment;

(c) Utilization of contextual factors, motivating operations, antecedent stimuli, positive reinforcement, and other consequences to help people develop new behaviors, increase or decrease existing behaviors, and emit behaviors under specific environmental conditions.

(2) "Practice of applied behavior analysis" does not include psychological testing, diagnosis of a mental or physical disorder, neuropsychology, psychotherapy, cognitive therapy, sex therapy, psychoanalysis, hypnotherapy, and long-term counseling as treatment modalities.

Sec. 4783.02. (A) Except as otherwise provided in division (B) of this section and section 4783.40 of the Revised Code, no person shall do either of the following:

(1) Engage in the practice of applied behavior analysis in this state without holding a certificate issued under section 4783.04 of the Revised Code;

(2) Hold the person's self out to be a certified Ohio behavior analyst unless the person holds a certificate issued under section 4783.04 of the Revised Code.

(B) This chapter does not apply to any of the following:

(1) An individual licensed under Chapter 4732. of the Revised Code to practice psychology, if the practice of applied behavior analysis engaged in by the licensed psychologist is within the licensed psychologist's education, training, and experience;

(2) An individual licensed under Chapter 4757. of the Revised Code to practice counseling, social work, or marriage and family therapy, if the practice of applied behavior analysis engaged in by the licensed professional counselor, licensed professional clinical counselor, licensed social worker, or licensed marriage and family therapist is within the licensee's education, training, and experience;

(3) An individual acting under the authority and direction of an individual described in division (B)(1) or (2) of this section;

(4) An individual practicing applied behavior analysis who is supervised by a certified Ohio behavior analyst and acting under the authority and direction of that certified Ohio behavior analyst;

(5) The delivery of interventions by a direct care provider or family member to implement components of an applied behavior analysis treatment plan.

(6) A behavior analyst who practices with nonhuman or nonpatient clients or consumers, including applied animal behaviorists and practitioners of organizational behavior management;

(7) A licensed professional authorized to practice in this state who, in the offering or rendering of services, does not represent oneself in any printed materials or verbally by incorporating the term "applied behavior analyst," if the services of the licensed professional are within the scope of practice of the licensing law governing the licensed professional and the services performed are commensurate with the licensed professional's education, training, and experience;

(8) A matriculated graduate student or postdoctoral trainee whose activities are part of a defined program of study or professional training;

(9) An individual employed by the department of developmental disabilities, a county board of developmental disabilities, or a council of government consisting of county boards of developmental disabilities, when the individual is acting in the scope of that employment;

(10) A professional employed in a school or other setting that falls under the regulation of the state board of education when the professional is acting within the scope of that employment.

(C) For purposes of division (B)(3) or (4) of this section, an individual is not subject to this chapter only if the licensed psychologist, the licensed professional counselor, the licensed professional clinical counselor, the licensed social worker, the licensed marriage and family therapist, or the certified Ohio behavior analyst under whose authority and direction the individual is acting pursuant to division (B)(3) or (4) of this section signs an attestation stating that the licensed psychologist, licensed professional counselor, licensed professional clinical counselor, licensed social worker, licensed marriage and family therapist, or certified Ohio behavior analyst is responsible for the care provided by the individual.

Sec. 4783.40. (A) Notwithstanding section 4783.02 of the Revised Code, an exam-eligible technician may engage in the practice of applied behavior analysis in this state in accordance with this section.

(B) To be eligible to practice as an exam-eligible technician pursuant to this section, an individual must be either of the following:

(1) The individual is in the process of becoming a registered behavior technician certified by the behavior analyst certification board and is practicing under the supervision of a certified Ohio behavior analyst or a board certified assistant behavior analyst holding a valid certification from the behavior analyst certification board.

(2) The individual has satisfied all of the following criteria:

(a) The individual holds a high school diploma or higher degree.

(b) The individual has completed any equivalent coursework or training requirements for registered behavior technicians required by the behavior analyst certification board or its successor organization.

(c) The individual has passed an initial competency assessment, or otherwise been found eligible, to sit for a psychometrically valid examination administered by a nationally accredited credentialing organization.

(C) An exam-eligible technician meeting the requirements of this section may engage in the practice of applied behavior analysis in this state under the supervision of a certified Ohio behavior analyst for a period of ninety days after the date the individual meets the requirements of division (B)(1) of this section. If the individual does not achieve certification as a certified Ohio behavior analyst by the end of that ninety-day period, the individual is no longer eligible to engage in the practice of applied behavior analysis as an exam-eligible technician.

Section 2. That existing sections 1751.84, 3923.84, 4783.01, and 4783.02 of the Revised Code are hereby repealed.

Section 3. PAYMENT RATES FOR ABA THERAPY SERVICES

For fiscal year 2027, the Department of Medicaid shall establish payment rates under the care management system established under section 5167.03 of the Revised Code, for applied behavior analysis therapy services used to treat Medicaid enrollees with a diagnosis of autism spectrum disorder. These payment rates shall equal one hundred per cent of the fee-for-service rate for current procedural terminology codes 97151 through 97158.