AB 1127

This bill requires health insurance policies to provide coverage for habilitative and rehabilitative speech therapies in certain circumstances. Under the bill, health insurance policies that provide coverage for habilitative services must provide coverage for habilitative speech therapy as a treatment for stuttering regardless of whether the stuttering is classified as developmental; health insurance policies that provide coverage for rehabilitative services must provide coverage for rehabilitative speech therapy as a treatment for stuttering; and health insurance policies that provide coverage for both habilitative services and rehabilitative services must provide coverage for habilitative speech therapy and rehabilitative speech therapy as a treatment for stuttering. The bill provides that covered speech therapies must include coverage of speech therapy provided in person or provided via telehealth. Self-insured governmental health plans are also required to provide the coverage specified in the bill. The coverage required under the bill may not be subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist; may not be limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; and may not be subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary. The bill provides several exceptions to this coverage requirement if the application of the coverage requirement to a qualified health plan would result in a requirement under federal law that the state pay to defray costs to qualified health plans.

The bill also expressly requires coverage of habilitative speech therapy and rehabilitative speech therapy as a treatment for stuttering by the Medical Assistance program, which is the state-administered Medicaid program that is jointly funded by the state and federal governments and that provides health services to individuals with limited financial resources.

Also, under current law, the juvenile court can order that a child is in need of protection or services (CHIPS order) and order the child’s parent or guardian or an appropriate agency to provide the child special treatment or care. The bill specifies that special treatment or care pursuant to a CHIPS order includes habilitative and rehabilitative speech therapies.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.