Understanding SB 676 in NC

SB 676 in North Carolina is also referred to as the “Autism Health Insurance Legislation”. It was passed by Governor McCory in October 2015 and has an implementation date of July 2016. The information below was taken from the Autism Society of North Carolina’s website 

What does it do?

• SB 676 requires health plans to cover treatment of autism for children up to age 18.
• Requires coverage of Adaptive Behavior Treatment, which includes Applied Behavioral Analysis (ABA) therapy and other evidence-based therapies such as TEACCH, Pivotal Response, etc.
• Coverage for Adaptive Behavior Treatment is limited to $40,000 per year.

Does this law cover all health insurance plans?

This law covers the large group plans for companies in North Carolina that follow state law. As we have pointed out in our policy paper on insurance, state laws can only affect certain kinds of health insurance plans that make up a small part of the health plan marketplace. Employers are more likely to offer coverage voluntarily, even when they are not required to do so, in states where coverage is required.

The law mentions DSM-5. Does this law require that children diagnosed under DSM-IV (4) be re-diagnosed using DSM-5 criteria to receive the autism benefit?

The law does not require re-diagnosis under DSM-5 criteria. DSM-5 changes to the insurance statutes reflect an update in the law. DSM-5 is now in effect, so the DSM-IV (4) language should not remain in the law. The DSM-5 specifically states that “individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.” 

Does SB 676 cover Applied Behavior Analysis (ABA)?

YES. The definition of Adaptive Behavior Treatment includes Applied Behavior Analysis as well as other treatments for autism. By using the broad term and not naming only one treatment option, the law allows for a range of behavioral and development interventions, including ABA, “that have been shown to be clinically effective.”

Does SB 676 allow ABA therapists (BCBAs) to provide ABA therapy in North Carolina and be reimbursed?

YES. ABA therapists (BCBAs) are already providing services in North Carolina and their services are being reimbursed. Even though they are not licensed, current law allows BCBAs to practice in NC as long as they are supervised. This law does not change any ability to work. The House passed a behavior analyst licensure bill to license BCBAs to practice without supervision. That bill is still eligible to be passed during the short session from April 25 to June 30, 2016. Many organizations worked together to come up with the licensure bill, and although the Autism Society of North Carolina does not typically take a position on the licensing of professional groups, ASNC has endorsed the bill and will be working to pass it in the Senate.

Contact us today to start taking advantage of this coverage!

Dr. Becca