Ohio Legislation

 Among many other things, this bill amends state insurance laws to:

• Require medicaid, individual and group health insurers, and public employee health plans that cover prescription drugs to cover abuse-deterrent opioid analgesics. Reimbursement may not be denied because a generic equivalent is available at a lower cost. Plans may not implement a requirement that a non abuse-deterrent is tried before coverage, and plans may not impose cost-sharing requirements higher than that of the lowest cost sharing requirements imposed on non abuse deterrent opioid analgesics.
• Require medicaid, individual and group health insurers, and public employee health plans to cover, without prior authorization and for as long as they are necessary, medication-assisted treatment, including medical, psychological treatment, prescribed drugs, and referral services for alcohol and drug abuse or addiction. The superintendent of insurance will establish and administer a program by January 1, 2019 to reimburse individual and group health insurers and public employee health plans for costs incurred by these requirements.

This bill requires health insurers to cover benefits associated with the screening, diagnosis, and treatment of autism spectrum disorders for individuals under the age of twenty-one. The minimum benefits an insurer must cover are listed below:

• 20 visits per year of speech/language therapy or occupational therapy by a licensed therapist
• 20 hours per week of clinical therapeutic intervention by or under the supervision of a licensed professional
• 30 visits per year of mental or behavioral health outpatient services by a licensed psychologists, psychiatrist, or other physician

Among other things, this bill requires all individual and group health plans and Medicaid plans that offer a prescription drug benefit to provide coverage for abuse-deterrent opioids. The bill also requires that any prior authorization requirements for abuse-deterrent opioids can not require a fail-first protocol. It also prohibits insurers from increasing cost-sharing requirements to cover any costs associated with this bill.

Among other things, this bill tries to change state law so that Medicaid care management system will cover “community-based behavioral health” services. Managed care organizations that administer these benefits must comply with the following requirements:

• Cannot use prior authorization for behavioral health services
• Cannot use visit limits for outpatient care or any other “arbitrary” quantitative treatment limitations
• Cannot deny a “qualified and willing provider” from becoming in-network providers

This bill tried to change the sections of the state law about parity so that plans would have to cover pervasive developmental disorder (autism). It required plans covered by those sections to also cover a $50,000 annual maximum for autism coverage. Pervasive developmental disorders were defined as:

• Autistic disorder
• Asperger’s disorder
• Pervasive developmental disorder not otherwise specified
• Rett’s syndrome
• Childhood disintegrative disorder

This bill tried to add sections to the state insurance law about autism coverage. Individual plans, small employer fully-insured plans, large employee fully-insured plans, and state and public employee plans would have been required to cover autism services. This bill required:

• $36,000 annual maximum
• Copayments, coinsurance, and deductibles must be the same as those in place for other medical services
• No visit limits for outpatient care
• Treatment includes (all of these are defined in depth in the bill):
  • Habilitative or rehabilitative care (includes applied behavior analysis )
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care
  • Counseling services
• Plans can only review child’s treatment plan once every 6 months
• Autism spectrum disorder is defined as autistic disorder, Asperger’s disorder, pervasive developmental disorder, Rett’s disorder, and childhood disintegrative disorder

This bill tried to change the sections of the state insurance law about parity. This would have changed the sections about “biologically-based” mental illness so that they would now apply to all mental health conditions and substance use disorders in the DSM or ICD. It also would have repealed the sections of the insurance law that applied to non “biologically-based” mental health conditions and coverage for “alcoholism.” (These sections of the law are summarized at the bottom of this page under “Ohio Parity Law.”

This bill tried to add sections to the state insurance law about autism coverage. Individual plans, small employer fully-insured plans, large employee fully-insured plans, and state and public employee plans would have been required to cover autism services. This bill required:

• $36,000 annual maximum
• Copayments, coinsurance, and deductibles must be the same as those in place for other medical services
• No visit limits for outpatient care
• Treatment includes (all of these are defined in depth in the bill):
  • Habilitative or rehabilitative care (includes applied behavior analysis )
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care
  • Counseling services
• Plans can only review child’s treatment plan once every 6 months
• Autism spectrum disorder is defined as autistic disorder, Asperger’s disorder, pervasive developmental disorder, Rett’s disorder, and childhood disintegrative disorder