Certain health plans would pay behavior therapy providers above Medicaid rates

State self-insured health plans and prepaid health plans would pay behavior analysis providers at least 110% of Medicaid's rate. It covers state self-insured health plans and state contracts with prepaid health plans. The payment rule applies when covered autism treatment includes behavior analysis services prescribed by a doctor under a treatment plan. The rule would apply to covered plans or contracts issued, delivered, amended, or renewed on or after July 1, 2026.

Insurers would pay behavior analysis providers at least 110% of Medicaid's rate for qualifying care. It covers insurance policies for sickness and injury. The payment rule applies only when the policy's required coverage pays for behavior analysis services. Those services do not include psychological testing, diagnosis, or counseling. The rule would apply to policies issued, delivered, amended, or renewed on or after July 1, 2026.

Health maintenance organizations would pay behavior analysis providers at least 110% of Medicaid's rate for qualifying care. It covers group and individual contracts with health maintenance organizations that provide basic health care. The payment rule applies when an enrollee receives covered behavior analysis services as part of autism treatment prescribed by a doctor under a treatment plan. The rule would apply to contracts entered into, delivered, amended, or renewed on or after July 1, 2026.