{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6060.21","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6060.21","heading":"Screening, diagnosis and treatment of autism spectrum","body":"disorder.\n\nA. For all plans issued or renewed on or after November 1,\n\n2016, a health benefit plan and the Oklahoma Employees Health\n\nInsurance Plan shall provide coverage for the screening, diagnosis\n\nand treatment of autism spectrum disorder in individuals. No\n\ninsurer shall terminate coverage, or refuse to deliver, execute,\n\nissue, amend, adjust or renew coverage to an individual solely\n\nbecause the individual is diagnosed with or has received treatment\n\nfor an autism spectrum disorder.\n\nB. Coverage under this section shall be subject to the\n\nprovisions set forth in Section 6060.11 of this title; provided,\n\nhowever, that coverage shall not be subject to any limits on the\n\nnumber of visits an individual may make for treatment of autism\n\nspectrum disorder.\n\nC. Coverage under this section shall not be subject to dollar\n\nlimits, deductibles or coinsurance provisions that are less\n\nfavorable to an insured than the dollar limits, deductibles or\n\ncoinsurance provisions that apply to substantially all medical and\n\nsurgical benefits under the health benefit plan.\n\nD. This section shall not be construed as limiting benefits\n\nthat are otherwise available to an individual under a health benefit\n\nplan.\n\nE. Coverage for applied behavior analysis shall include the\n\nservices provided or supervised by a board-certified behavior\n\nanalyst, a board-certified assistant behavior analyst or a licensed\n\ndoctoral-level psychologist.\n\nF. Except for inpatient services, if an insured is receiving\n\ntreatment for an autism spectrum disorder, an insurer shall have the\n\nright to review the treatment plan annually, unless the insurer and\n\nthe insured's treating physician or psychologist agree that a more\n\nfrequent review is necessary. Any such agreement regarding the\n\nright to review a treatment plan more frequently shall apply only to\n\na particular insured being treated for an autism spectrum disorder\n\nand shall not apply to all individuals being treated for autism\n\nspectrum disorder by a physician or psychologist. The cost of\n\nobtaining any review or treatment plan shall be borne by the\n\ninsurer.\n\nG. This section shall not be construed as affecting any\n\nobligation to provide services to an individual under an\n\nindividualized family service plan, an individualized education\n\nprogram or an individualized service plan.\n\nH. As used in this section:\n\n1. \"Applied behavior analysis\" means the design, implementation\n\nand evaluation of environmental modifications, using behavioral\n\nstimuli and consequences, to produce socially significant\n\nimprovement in human behavior including the use of direct\n\nobservation, measurement and functional analysis of the relationship\n\nbetween environment and behavior;\n\n2. \"Autism spectrum disorder\" means any of the pervasive\n\ndevelopmental disorders or autism spectrum disorders as defined by\n\nthe most recent edition of the Diagnostic and Statistical Manual of\n\nMental Disorders (DSM) or the edition that was in effect at the time\n\nof diagnosis;\n\n3. \"Behavioral health treatment\" means counseling and treatment\n\nprograms including applied behavior analysis, that are:\n\na. necessary to develop, maintain or restore, to the\n\nmaximum extent practicable, the functioning of an\n\nindividual, and\n\nb. provided or supervised by a board-certified behavior\n\nanalyst, a board-certified assistant behavior analyst\n\nor by a licensed doctoral-level psychologist so long\n\nas the services performed are commensurate with the\n\npsychologist's university training and experience;\n\n4. \"Diagnosis of autism spectrum disorder\" means medically\n\nnecessary assessment, evaluations or tests to diagnose whether an\n\nindividual has an autism spectrum disorder;\n\n5. \"Health benefit plan\" means any plan or arrangement as\n\ndefined in subsection C of Section 6060.4 of Title 36 of the\n\nOklahoma Statutes;\n\n6. \"Oklahoma Employees Health Insurance Plan\" means \"Health\nle 36. Insurance Page 1117\n\n4. \"Diagnosis of autism spectrum disorder\" means medically\n\nnecessary assessment, evaluations or tests to diagnose whether an\n\nindividual has an autism spectrum disorder;\n\n5. \"Health benefit plan\" means any plan or arrangement as\n\ndefined in subsection C of Section 6060.4 of Title 36 of the\n\nOklahoma Statutes;\n\n6. \"Oklahoma Employees Health Insurance Plan\" means \"Health\n\nInsurance Plan\" as defined in Section 1303 of Title 74 of the\n\nOklahoma Statutes;\n\n7. \"Pharmacy care\" means medications prescribed by a licensed\n\nphysician and any health-related services deemed medically necessary\n\nto determine the need or effectiveness of the medications;\n\n8. \"Psychiatric care\" means direct or consultative services\n\nprovided by a psychiatrist licensed in the state in which the\n\npsychiatrist practices;\n\n9. \"Psychological care\" means direct or consultative services\n\nprovided by a psychologist licensed in the state in which the\n\npsychologist practices;\n\n10. \"Therapeutic care\" means services provided by licensed or\n\ncertified speech therapists, occupational therapists or physical\n\ntherapists; and\n\n11. \"Treatment for autism spectrum disorder\" means evidence-\n\nbased care and related equipment prescribed or ordered for an\n\nindividual diagnosed with an autism spectrum disorder by a licensed\n\nphysician or a licensed doctoral-level psychologist who determines\n\nthe care to be medically necessary including, but not limited to:\n\na. behavioral health treatment,\n\nb. pharmacy care,\n\nc. psychiatric care,\n\nd. psychological care, and\n\ne. therapeutic care.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"58bddc4cd800be072d21817e194494b8cbc515b1383b566280d71165e40473f1","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6060.20","next":"us-ok/okla.-stat.-tit.-36-36-6060.22"},"notice":"GroundRules: Original legal text. Not legal advice."}