Avera and Sanford Health Care Plans Announcing New Coverage

South Dakota Governor Kristi Noem announced on Friday that the two states leading health care providers will begin offering Applied Behavioral Analysis (ABA) therapy in 2020.

Governor Noem says, “After talking with parents of kids with autism and assessing the coverage options available, we recognized the need for an alternative option."

According to the release, South Dakota obtained approval earlier this year 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.

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 November 1, 2019, with coverage effective January 1, 2020.