A BILL FOR AN ACT to amend the Indiana Code concerning insurance.
HB 1103 requires certain Indiana health coverage arrangements to cover treatment for autism spectrum disorder and, when that treatment includes applied behavior analysis (ABA), to reimburse ABA providers at no less than 110% of the Medicaid reimbursement rate. The bill applies this requirement to the state employee health plan, accident and sickness insurance policies, and health maintenance organization (HMO) contracts, with the new provisions applying to policies or contracts issued, delivered, amended, or renewed after June 30, 2026.
The bill defines “behavior analysis services” broadly as services involving the design, implementation, and evaluation of behavioral interventions intended to produce socially significant improvements in behavior, while expressly excluding services such as psychological testing, diagnosis, psychotherapy, cognitive therapy, psychoanalysis, hypnotherapy, counseling, and related mental health services. It also preserves existing autism coverage rules by stating that coverage for autism spectrum disorder treatment must be prescribed by the treating physician and may not be subject to less favorable cost-sharing than coverage for physical illness generally.
HB 1103 would amend multiple sections of the Indiana Code governing state employee health coverage, accident and sickness insurance, and HMO contracts. Its main legal effect is to add a specific reimbursement floor for ABA services tied to Medicaid rates, while reinforcing existing autism-related coverage mandates and anti-discrimination protections in health plans. Insurers, HMOs, and the state employee health plan would need to adjust benefit administration and provider reimbursement practices for affected policies and contracts beginning July 1, 2026.
Based on the bill text and the absence of recorded committee testimony or votes in the provided materials, the overall sentiment appears supportive of expanding and standardizing coverage for autism treatment, especially ABA services. The bill is framed as a coverage and reimbursement measure rather than a restriction, suggesting a consumer- and provider-supportive policy approach. No formal opposition is documented in the provided record.
The most likely point of contention is the mandated reimbursement level of 110% of Medicaid rates, which could raise cost concerns for insurers, HMOs, and the state employee health plan. Another potential issue is the scope of the definition of behavior analysis services and the exclusion of other behavioral health services, which may prompt questions about what treatments qualify for the higher reimbursement standard. The bill also may draw attention from stakeholders concerned about premium impacts, provider network adequacy, and whether the reimbursement floor is sufficient or excessive relative to market rates.