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Legislation Signed into Law

2013-2014

HB2744
Introduced: 3/2014)
Sponsor: Committee on Taxation
Status: Signed into law 4/2014
Summary: This bill changed the state insurance law to include the current section that requires insurance plans to cover treatment for autism. The autism section of the insurance law in Kansas is very detailed. Please scroll to the bottom of this page to read a summary of that section of the law.
This bill also created the Applied Behavior Analysis Licensure Act, which is set to take effect on July 1, 2016. This section of the bill (sections 2-6) has very detailed standards for any provider who practices applied behavior analysis for children with autism.

2009-2010

HB 2160(pdf | Get Adobe® Reader®)
Introduced: 2010
Sponsor: Unknown
Status: Signed into law 4/2010
Summary: This bill created the section of the state law that requires insurance plans for state government employees to cover autism services. A summary of that section of the law can be found at the bottom of the page.

Primary Focus: Parity: General
Title/Description: Kansas mental health parity act; insurance coverage for services rendered in the treatment of mental illnesses, alcoholism, drug abuse or substance use disorders; limitations.
Citation: K.S.A. § 40-2,105a
Summary: Any group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization that provides medical, surgical or hospital expense coverage shall include coverage for diagnosis and treatment of mental illnesses and alcoholism, drug abuse or other substance use disorders.
Effective Date: July 1, 2009
Notes: Enacted by 2001 Kan. HB 2033; alcoholism, drug abuse, or substance use disorder provisions enacted by 2009 Kan. HB 2214.

Primary Focus: Parity: General
Title/Description: Insurance coverage under individual or small employer group policies for services rendered in treatment of mental illness, alcoholism, drug abuse or substance use disorders; limitations; exceptions.
Citation: K.S.A. § 40-2,105
Summary: Every insurer that issues any individual policy of accident and sickness insurance or group policy of accident and sickness insurance to a small employer that provides medical, surgical or hospital expense coverage for other than specific diseases or accidents only and that provides for reimbursement or indemnity for services rendered to a person covered by such policy in a medical care facility, must provide for reimbursement or indemnity under such individual policy or under such small employer group policy that shall be limited to not less than 45 days per year for in-patient treatment of mental illness in a licensed medical care facility, and not less than 30 days per year when such person is confined for treatment of alcoholism, drug abuse or substance use disorders in a licensed treatment facility for alcoholics, a licensed treatment facility for drug abusers, a licensed community mental health center or clinic, or a licensed psychiatric hospital.
Such individual policy or such small employer group policy shall also provide for reimbursement or indemnity of the costs of treatment of such person for mental illness, alcoholism, drug abuse and substance use disorders subject to the same deductibles, copayments, coinsurance, out-of-pocket expenses and treatment limitations as apply to other covered services, limited to not less than $15,000 in such person’s lifetime, with no annual limits, in the facilities enumerated when in-patient treatment is not necessary for the treatment or by a physician licensed or psychologist licensed to practice under the laws of the state of Kansas.
Effective Date: July 1, 2009
Notes: Enacted by Kan. HB 2214.

Primary Focus: Parity: General
Title/Description: Group policies; mental illness, alcoholism, drug abuse or substance use disorder; limitations; exceptions; definitions.
Citation: K.S.A. § 40-2258
Summary: An accident and sickness insurer which offers coverage through a group policy or certificate of coverage providing hospital, medical or surgical expense benefits, which includes mental illness or alcoholism, drug abuse or other substance use disorder benefits shall may not impose any aggregate lifetime limit on mental illness or alcoholism, drug abuse or other substance use disorder benefits if the policy does not include an aggregate lifetime limit on substantially all hospital, medical and surgical expense benefits.
Effective Date: July 1, 2009
Notes: Enacted by 1997 Kan. SB 204; most recently amended by Kan. HB 2214 to include mental illness.

Kansas Parity Law

The section of Kansas law about parity is in the state Insurance Code. There is one section for small employer fully-insured plans and individual plans , and another section for large employer fully-insured plans . There is also a very extensive section about autism in the Insurance Code. This is not a comprehensive parity law because it allows small employer fully-insured plans and individual plans to use treatment limitations for for some behavioral health services that are not necessarily in place for other medical services.

For plans that aren’t small employer fully-insured plans or individual plans, the law requires coverage for behavioral health services and that all financial requirements and treatment limitations are the same as what the plans have in place for other medical services. The law defines treatment limitations as “limits on the frequency of treatment, number of visits, days of coverage or other similar limits on the scope or duration of treatment.“ This section of the law makes it clear that it applies to inpatient and outpatient care and that any mental illness or substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders is covered.

For small employer fully-insured plans and individual plans, the law says that they must cover at least 45 days of inpatient care for mental illness and 30 days of inpatient care for substance use disorders. The law says that that financial requirements for inpatient care must be the same as those used for other inpatient medical care. The law does not require small employer fully-insured plans and individual plans to cover outpatient care.

The law reminds plans that they must follow the section of the state law about utilization review when they use utilization review for mental illness services.

There is also another section of the State Insurance Code that says that insurance plans must cover prescription medications for mental illness on the same terms and conditions as they cover prescription medications for other medical conditions.

Autism Coverage

The section about autism for large employer fully-insured plans, small employer fully-insured plans, and individual plans is very comprehensive. Please keep in mind that being comprehensive does not necessarily mean a law is better or worse than a less extensive law.

This section requires all insurance plans to cover autism services for all children through age 11. However, coverage for applied behavioral analysis (ABA) is different in terms of age:

  1. 1300 hours of ABA per year for birth to age 5
  2. 520 hours per year for age 6 through age 11
  3. These annual limits can be exceeded if the insurance plan decides it is medically necessary

This section has specific language saying that insurance plans can deny coverage for anything it determines is not medically necessary or if the plan decides that the child has “reached the maximum medical improvement.” Insurance plans can review the treatment plan designed by the child’s provider no more than once every 6 months.

This section gives very detailed definitions for:

  1. Autistic disorder
  2. Asperger’s disorder
  3. Pervasive developmental disorder not otherwise specified
  4. Rhett’s disorder
  5. Childhood disintegrative disorder

To read the specifics of these definitions, please click the link above (links to 40-2,194) and scroll to section b (lowercase b) that reads “For the Purposes of This Section.”

This section also clearly states that once a child has been diagnosed with autism, he or she won’t be required to receive another diagnosis if a future edition of the Diagnostic and Statistical Manual of Mental Disorders changes the criteria for any of the above-mentioned conditions.

This section also clearly states that all financial requirements must be the same as the financial requirements used for other medical care and that there can’t be any annual limits on the number of times a child sees an autism services provider.

There is another section of state law about autism coverage that is only for state government employees. This section of the law similar to what is listed above for large employer fully-insured plans, small employer fully-insured plans, and individual plans. However, there are some important ways in which it is different:

  • Coverage is for anyone under age 19.
  • There is a $36,000 annual maximum for anyone under age 7 and a $27,000 annual maximum for age 7-18.
  • The definition of autism spectrum disorder is much less detailed and only mentions autistic disorder, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified.
  • There is no limit on how often the insurance plan can review the child’s treatment plan.
  • There is no section that states that once a child has been diagnosed with autism, he or she won’t be required to receive another diagnosis if a future edition of the Diagnostic and Statistical Manual of Mental Disorders changes the diagnostic criteria for autism spectrum disorder.
  • There is no language that forbids annual limits on the number of times a child sees an autism service provider.

Get Support

Kansas Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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