Sanford Health Plan to Offer Applied Behavioral Analysis Coverage in 2020

PIERRE, South Dakota, Oct. 11 -- Sanford Health issued the following news:

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- Applied Behavioral Analysis can be used as behavior therapy for autism patients

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Gov. Kristi Noem, in conjunction with Avera Health Plans and Sanford Health Plan, announced health insurance coverage options that include Applied Behavioral Analysis (ABA) therapy in the South Dakota insurance market for 2020.

"As governor and as a mom, I understand how important it is to get kids the kind of care they need," said Noem. "After talking with parents of kids with autism and assessing the coverage options available, we recognized the need for an alternative option. I'm thrilled to announce Avera and Sanford have found a way to provide added coverage options for kids and families with autism."

Earlier this year, South Dakota obtained approval under the federal review process to update the Essential Health Benefits benchmark plan. In 2021, all Affordable Care Act (ACA) individual and small group plans will be required to include coverage for ABA therapy for the treatment of autism spectrum disorder. Federal deadlines and plan filing requirements set the implementation date for plan year 2021.

Noem, Avera Health Plans and Sanford Health Plan recognized a delay in implementing coverage for ABA therapy could have a significant impact on the children the therapy is designed to help.

The result is a short-term solution where both carriers will offer at least one individual health insurance plan option for 2020. The plan(s) offered will include coverage for ABA therapy at the benchmark level approved by the Centers for Medicare and Medicaid earlier this year. They will be offered directly through each carrier outside of the ACA Marketplace, meaning the plans will not be available on the exchange.

ABA therapy services will be subject to the individual carrier's plan management programs, medical necessity reviews, and preauthorization requirements.

Open enrollment for plans offered in 2020 will begin on Nov. 1, 2019, with coverage effective Jan. 1, 2020.