Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Hb 453 topic
No spam. Unsubscribe anytime.
Witnesses urge removal of caps and higher reimbursement in House Bill 453 to expand ABA access
Summary
Proponents told the House Insurance Committee HB 453 would modernize Ohio’s autism insurance framework by removing age/hour/visit limits, requiring coverage for medically necessary ABA and related therapies, supporting updated Medicaid-based reimbursement and allowing supervised exam-eligible technicians to bill; witnesses cited provider shortages, cost‑shift to Medicaid and actuarial work by Milliman.
Multiple proponent witnesses testified in support of House Bill 453, which supporters say modernizes Ohio's autism insurance framework by removing age, hour and visit limits and requiring coverage for medically necessary services including applied behavior analysis (ABA), speech and occupational therapy when delivered by appropriately licensed professionals.
Lindsay Paden Cargill (Bridgeway Therapy Center) described the clinical need for evidence‑based interventions and urged the committee to remove outdated caps that interrupt care. Emily Karhoff (Ohio Association for Behavior Analysts) said her organization represents over 1,500 behavior analysts and argued commercial insurers should follow industry standards for medical necessity and reimburse at or above updated Medicaid ABA fee schedules; she cited the Milliman actuarial work used to set updated rates. Jennifer Gonda (Community Behavior Consulting) and Marla Root (Ohio Autism Insurance Coalition) described provider workforce pressures and the fiscal consequences of underpayment; Root said coalition provider cost was $67/hour, Milliman’s rate was $64/hour and that some commercial payers reimburse below the current Medicaid rate (cited at $50.76/hour), producing cost‑shifting into Medicaid.
Witnesses also said Ohio currently faces capacity constraints (one witness said 1 in 36 children have autism and estimated roughly 71,000 children in the state; an estimated one‑third might need ABA services) and that only a small share of Medicaid‑eligible children currently receive ABA. Proponents urged the committee to adopt individualized medical‑necessity determinations, require commercial payers to pay at least 100% of newly developed Medicaid rates, and allow exam‑eligible registered technicians to begin providing services under supervision to expand capacity.
Committee members asked for data on the number of affected individuals, whether reimbursement increases in other states produced more providers, and how expansion could affect insurer participation. Witnesses said actuarial work and Department of Medicaid draft rules exist and that stakeholders have engaged in extensive processes; they offered to provide additional data and analyses to the committee.
