Section 764p - [Effective 12/16/2024] Speech Therapy for Stuttering.(a) A health insurance policy offered, issued or renewed in this Commonwealth shall provide coverage for habilitative speech therapy treatment and rehabilitative speech therapy treatment for childhood stuttering.(b) The coverage required under this section shall be subject to the terms and conditions of a health insurance policy, including provisions relating to medical necessity, cost-sharing and utilization review.
(c) This section shall not be construed to require an insurer to cover school-based speech therapy for childhood stuttering based solely on inclusion of the therapy in an individualized education program.(d)(1) Except as provided in paragraph (2), the terms in this section shall be given the same meaning as in section 2102 of this act.(2) As used in this section, the following words and phrases shall have the meanings given to them in this paragraph unless the context clearly indicates otherwise: "Childhood stuttering" means a speech disorder characterized by repetition of sounds, syllables or words, prolongation of sounds and interruptions in speech developed between two and six years of age.
"Cost-sharing" means:
(1) The share of the health care costs covered by a health insurance policy that an enrollee or covered person pays out-of-pocket.(2) The term includes a deductible, coinsurance, copayment or similar charge.(3) The term does not include a premium, a balance billed amount from an out-of-network provider or the cost of a noncovered service. "Habilitative speech therapy treatment" means speech therapy that helps an individual to keep, learn or improve skills and functioning for daily living.
"Rehabilitative speech therapy treatment" means speech therapy that helps an individual restore or improve skills and functioning for daily living that have been lost or impaired.
"Speech therapy" means the therapeutic care provided to an individual for treatment administered by a licensed speech-language pathologist.
Added by P.L. (number not assigned at time of publication) 2024 No. 104,§ 1, eff. 12/16/2024.Section 2 of the 2024 enacting legislation provides that: "This act shall apply as follows: (1) For health insurance policies for which either rates or forms are required to be filed with the Federal Government or the Insurance Department, this act shall apply to any policy for which a form or rate is first filed on or after 180 days after the effective date of this paragraph. (2) For health insurance policies for which neither rates nor forms are required to be filed with the Federal Government or the Insurance Department, this act shall apply to any policy issued or renewed on or after 180 days after the effective date of this paragraph."