What Autism Services Are Covered Under Behavioral Health?
The Centers for Affliction Command and Prevention (CDC) estimates that an average of 1 in 54 children have an autism spectrum disorder (ASD). More children than always before are beingness classified every bit having autism spectrum disorders.
At that place is no cure for autism, but it is a treatable condition. Most health professionals agree that early intervention treatment programs are important. Treatment options may include behavioral and educational interventions, complementary and alternative medicine, dietary changes or medications to manage or relieve the symptoms of autism. These treatments may be plush. Co-ordinate to the CDC, the boilerplate medical expenditures of a child with ASD exceed those without past $iv,110 – $6,200 per year. Costs include health care, pedagogy, ASD-related therapy, family unit-coordinated services and caregiver time. In addition to these medical costs, intensive behavioral interventions for children with ASD costs $40,000 to $lx,000 per kid per yr. Intensive behavioral interventions may consist of 20-40 hours per calendar week of individualized instruction for children four or younger who usually continue for ii-3 years.
Most states require insurers to provide coverage for the handling of autism. All the same, opponents of this approach argue that care for individuals with autism is the responsibleness of parents and the school systems. Others have raised concerns that mandating coverage for autism will significantly increase insurance premiums. According to the American University of Pediatrics, state insurance mandates were associated with a 16% increase in board-certified behavioral analysts. This debate has intensified, and states are taking a variety of approaches to meet the needs of children and adults with autism.
Mandated coverage may exist limited to specific historic period groups, number of annual visits, an almanac spending cap or other limitations.
| State | Statute Summary |
|---|---|
| Alabama | Ala. Code § 27-54A-1 et. seq (2012) establish the Riley Ward Act and require a wellness do good plan to offer coverage for the screening, diagnosis and treatment of autism spectrum disorders for an insured child who is xviii years of historic period or under in policies and contracts issued or delivered to employers with at least 51 employees for at least l% of working days during the preceding calendar year. Handling is defined every bit treatment that is prescribed by the child's physician or psychologist in accord with a handling program and may include behavioral wellness treatment (including applied behavior assay), pharmacy intendance, psychiatric intendance, psychological care and therapeutic care. The coverage required may not exist subject to dollar limits, deductibles or coinsurance provisions that are less favorable to an insured than the limits or deductibles that employ to affliction generally nether the health insurance plan. Except for coverage for behavioral therapy, which is subject area to a $40,000 maximum benefit per yr for a child between 0-9 years of age, a $thirty,000 maximum benefit per twelvemonth for a child betwixt ten-xiii years of age and a $20,000 maximum benefit per year for a child between xiv-xviii years of age. Ala. Code § 22-1-18 (2017) provides coverage and reimbursement for the treatment of autism spectrum disorder under the Children'southward Wellness Insurance Programme. Ala. Code § 22-6-xiv (2017) provides coverage and reimbursement for the treatment of autism spectrum disorder under the Alabama Medicaid program. |
| Alaska | Alaska Stat. § 21-42-397 (2012) requires health care insurers, except for a fraternal benefit social club, to provide coverage for the costs of diagnosis and treatment of autism spectrum disorders. Covered handling includes medically necessary pharmacy care, psychiatric care, psychological intendance, habilitative or rehabilitative intendance (including practical behavior analysis), and therapeutic care. Coverage is only required for individuals nether 21 years of age, and the number of visits to an autism service provider for handling may not be limited. Coverage is subject to copayment, deductible and coinsurance provisions included in a wellness insurance policy to the same extent as other wellness care services covered by the policy. An insurer providing insurance to a minor employer in the grouping market with 20 or fewer employees is not required to provide this coverage, and the coverage requirement may exist waived for an insurer providing insurance to a small employer with 21-25 employees if the small employer demonstrates that compliance with the requirement increased the premium cost of the pocket-size employer's health policy by 3% or more during a sequent 12-month menstruation. |
| Arizona | Ariz. Rev. Stat. Ann. § twenty-826.04, § 20-1057.xi, § 20-1402.03 and § 20-1404.03 (2008) crave policies issued by certain wellness insurers, first July 1, 2009, to provide coverage for the diagnosis and treatment of autism spectrum disorders, with some limitations. Coverage for autism treatment may not be excluded or denied and dollar limits, deductibles and coinsurance cannot be imposed based solely on the diagnosis of an autism spectrum disorder. Coverage for medically necessary behavioral therapy services may non be excluded or denied and is subject to a $50,000 maximum benefit per year for an eligible person upwards to the age of 9 and a $25,000 maximum benefit per year for an eligible person who is betwixt the ages of nine and 16 years. |
| Arkansas | Ark. Stat. Ann. § 23-99-418 (2011) requires health benefit plans to provide coverage for the diagnosis and handling of autism spectrum disorders. Treatment is defined to include applied behavior analysis, pharmacy intendance, psychiatric care, psychological care, therapeutic care, necessary equipment to provide evidence-based treatment, and any care that a licensed md determines to be medically necessary and evidence-based. Applied behavioral analysis is express to $50,000 annually and to children under 18 years of historic period. Coverage is not subject to whatever limits on the number of visits an individual may make to an autism services provider. The law specifies that on or after Jan i, 2014, to the extent that these provisions require benefits that exceed the essential health benefits specified nether the federal Patient Protection and Affordable Care Act, the benefits that exceed the essential health benefits shall not be required of a wellness benefit plan when a health care insurer offers the plan in the state through the state medical substitution. |
| California | Cal. Insurance Code § 10144.51 (2017) requires every health insurance policy to provide coverage for behavioral wellness treatment for pervasive developmental disorder or autism. The constabulary likewise specifies that this provision does not require any benefits to be provided that exceed the essential health benefits required by the Patient Protection and Affordable Care Act. Cal. Health and Safety Code § 1374.73 (2017) requires every health care service programme contract that provides infirmary, medical or surgical coverage to provide coverage for behavioral health treatment for pervasive developmental disorder or autism. The law specifies that this provision does not require any benefits that exceed the essential health benefits required by the Patient Protection and Affordable Intendance Act. |
| Colorado | Colo. Rev. Stat. § ten-xvi-104 (1992) requires that all wellness benefit plans provide coverage for a child's assessment, diagnosis, and treatment of autism spectrum disorders. Treatment for autism spectrum disorders is defined to include treatments that are medically necessary, appropriate, effective or efficient and shall include evaluation and assessment services; behavior training and direction and applied beliefs analysis; habilitative or rehabilitative intendance, including occupational, physical or speech therapy; pharmacy care and medication; psychiatric care; psychological care; and therapeutic care. |
| Connecticut | Conn. Gen. Stat. § 38a-514b (2009) requires specified group health insurance policies to provide coverage for the diagnosis and treatment of autism spectrum disorder. Treatments must be medically necessary and identified and ordered by a licensed physician, psychologist or clinical social worker in accordance with a treatment plan. Treatments may include behavioral therapy, prescription drugs, psychiatric services, psychological services, physical therapy, voice communication and language pathology services and occupational therapy. The policy may not impose limits on the number of visits to an autism services provider. Conn. Gen Stat. § 38a-488b (2009) requires individual health insurance policies to provide coverage for concrete, speech, and occupational therapy services for the handling of autism spectrum disorder, equally defined by the American Psychiatric Association's "Diagnostic and Statistical Transmission of Mental Disorders (DSM)," to the extent such services are a covered benefit for other diseases and conditions. |
| District of Columbia | D.C. Code Ann. § 31-3271 and § 31-3272 (2007) require health insurers to provide habilitative services for children less than 21 years of age. The coverage shall not be more than restrictive than coverage provided for any other illness, condition or disorder. A health insurer shall not be required to provide reimbursement for habilitative services delivered through early on intervention or schoolhouse services. |
| Delaware | Del. Lawmaking Ann. tit. eighteen, §3366 (2011) provides that all individual health benefit plans shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders in individuals less than 21 years of historic period. It also specifies annual coverage limits for applied behavior analysis, provides that coverage shall non be subject to dollar limits that are less favorable than dollar limits for concrete illness, and provides that an insurer will have the correct to request a review of the treatment. |
| Florida | Fla. Stat. § 627.6686 and § 641.31098 (2008) established the Steven A. Geller Autism Coverage Act and require health insurance plans and health maintenance contracts to provide coverage to eligible individuals for well-baby and well-kid screening for diagnosing the presence of autism spectrum disorders, treatment of autism spectrum disorders through speech, occupational and physical therapy and practical behavior analysis. Coverage is express to treatment that is prescribed by the insured's treating physician in accordance with a handling plan and is limited to $36,000 annually and may non exceed $200,000 in full lifetime benefits. |
| Georgia | Ga. Code § 33-24-59.10 (2001) requires accident and sickness contracts, policies or benefit plans to provide for medically necessary autism spectrum disorder coverage for children 20 years of age or under. The policy or contract should not limit the number of visits and coverage for applied beliefs analysis is limited to $35,000 per yr. |
| Illinois | Ill. Rev. Stat. ch. 215, § five/356z.14 et seq. crave all private and group accident and health insurance or managed care plans to provide coverage for the diagnosis and treatment of autism spectrum disorders for individuals less than 21 years of age. Coverage is to include applied behavioral analysis and other treatments with a maximum do good of $36,000 per year. |
| Indiana | Ind. Code § 27-8-14.ii-ane et seq. and § 27-xiii-seven-xiv.vii (2001) require an accident and sickness insurance policy that is issued on a group footing and a group contract with a wellness maintenance organisation to provide coverage for the treatment of a pervasive developmental disorder. Coverage is limited to handling that the insured's treating medico prescribes in accord with a treatment plan. An insurer may non deny or turn down to issue coverage or otherwise terminate or restrict coverage on an private under an insurance policy solely because the individual is diagnosed with a pervasive developmental disorder. An insurer that issues an accident and sickness insurance policy on an individual basis or a health maintenance organization that enters an individual contract that provides basic health care services must offering to provide coverage for the treatment of a pervasive developmental disorder of an enrollee. |
| Iowa | Iowa Code § 514C.28 (2010) requires land employee health intendance plans to provide coverage for the diagnosis and treatment of autism spectrum disorders for individuals nether 21 years of age. Handling is defined as pharmacy care, psychiatric care, psychological care, rehabilitative care and therapeutic care. The coverage programme cannot limit the number of visits to an autism service provider for handling. Coverage must be provided in coordination with requirements established in Iowa Code § 514c.22. Iowa Code § 514c.22 (2005) requires specified insurers to provide coverage benefits for handling of a biologically based mental illness, including pervasive developmental disorders and autistic disorders. |
| Kansas | Kan. Stat. Ann. § 75-6524 (2010) requires state employee wellness insurance plans to provide coverage for the diagnosis and treatment of autism spectrum disorder for any covered individual up to xix years old. The annual do good cap for children upwardly to age vii is $36,000 and $27,000 for children from age 7 upwardly to historic period xix. The law also requires the state employees' health care commissioner to submit a report to the legislature that includes information on the affect of the mandated coverage for autism spectrum disorder on the country health intendance benefits program, information on the utilization of coverage and the toll of providing such coverage and recommendations for whether such coverage should continue. |
| Kentucky | Ky. Rev. Stat. § 18A.225 requires land employee health benefit plans to provide coverage for the diagnosis and treatment of autism spectrum disorder consistent with the requirement for coverage under large group wellness benefit plans. Ky. Rev. Stat. § 304.17A-142 requires all health do good plans to provide coverage for the diagnosis and treatment of autism spectrum disorders. Coverage may not be subject field to any limits on the number of visits an individual may make to an autism services provider. Treatment of autism spectrum disorders is divers to include medical care, chemist's intendance (if covered by the plan), psychiatric intendance, psychological intendance, therapeutic care, applied beliefs analysis, and rehabilitative and habilitative care. |
| Louisiana | La. Rev. Stat. Ann. § 22:1050 (2008) requires wellness insurance policies, including health maintenance organizations, to provide coverage for diagnosing and treating autism spectrum disorders in individuals less than 21 years of age. Coverage is subject to a maximum do good of $36,000. Treatment of autism spectrum disorders is defined to include habilitative or rehabilitative care (including applied behavior assay), pharmacy, psychiatric, psychological and therapeutic care. |
| Maine | Me. Rev. Stat. Ann. Tit. 24-A § 2768 (2011) requires all individual health insurance policies and contracts to provide coverage for the diagnosis and treatment of autism spectrum disorders for individuals 10 years of age and under. Treatment is divers as habilitative or rehabilitative care, practical behavior analysis, counseling services and therapy services, including speech, occupational and physical therapy. The policy or contract may limit coverage for practical behavior analysis to $36,000 per yr, and the insurance policy or contract may not include whatever limits on the number of visits. Me. Rev. Stat. Ann. tit. 24 § 2325-A; tit. 24-A § 2749-C, § 2843 and § 4234-A require specified group contracts to provide, at a minimum, benefits for a person receiving medical treatment for specified mental illnesses, including pervasive developmental disorders. Other specified private and group insurance contracts or policies must make available benefits for treating and diagnosing specified mental illnesses, including pervasive developmental disorder or autism, under terms and conditions that are no less extensive than the benefits provided for medical handling for physical illnesses. |
| Maryland | Md. Insurance Code Ann. § 15–835 (2000) requires insurers and nonprofit health service plans and health maintenance organizations to provide coverage for habilitative services to children nether the age of 19 years. This section also requires insurers to use the regulations adopted by the commissioner to determine whether the habilitative services covered are medically necessary and advisable to treat autism and autism spectrum disorders. Md. Code Regs. 31.10.39.00 et. seq (2014) establish how insurers should apply utilization review criteria and impose documentation requirements regarding the treatment of autism and autism spectrum disorders in one case it is a covered benefit under a health plan. |
| Massachusetts | Mass. Gen. Laws. ch. 32A §25, ch. 175 §47AA, ch. 176A §8DD, ch. 176B §4DD; ch. 176G §4V requires specified private, group and state employee health plans and health maintenance contracts to provide benefits on a nondiscriminatory footing for the diagnosis and treatment of autism spectrum disorder. Treatment is defined to include habilitative or rehabilitative, chemist's shop, psychiatric, psychological and therapeutic care. The health programme may not contain an almanac or lifetime dollar or unit of service limitation on coverage for autism which is less than the limitations imposed on coverage for physical conditions. The plan may not limit the number of visits an individual may make to an autism services provider. The law allows for exemptions from providing coverage under certain circumstances. Mass. Gen. Laws ch. 32A §22, ch. 175 §47B, ch. 176A §8A, ch. 176B §4A, ch. 176G §4M requires an individual policy and a grouping blanket or general policy of accident and sickness insurance or a health maintenance contract that provides infirmary and surgical insurance to provide mental health benefits on a nondiscriminatory basis for the diagnosis and handling of specified biologically-based mental disorders, including autism. Mass. Gen. Laws Ann. ch. 118E, §10H requires the sectionalization of medical aid within the executive office of health and human services to provide medical coverage for persons younger than 21 years who are diagnosed with an autism spectrum disorder. Coverage includes simply is non limited to practical behavior analysis and non-dedicated augmentative and alternative advice devices. This coverage is dependent on the availability of federal funds. |
| Michigan | Mich. Comp. Laws § 500.3406s, § 550.1416e (2012) require health maintenance organization group, individual contract, wellness care corporation group or nongroup certificate to provide coverage for the diagnosis and treatment of autism spectrum disorders. Coverage for treatment may be field of study to a maximum annual benefit of $l,000 for children through age 6, $twoscore,000 for a child age 7 through 12 and $30,000 for a child age 13 through 18. Treatment is defined to include behavioral health treatment (including applied beliefs analysis), pharmacy care, psychiatric care, psychological intendance and therapeutic care. Mich. Comp. Laws § 550.1831 et. seq cover the Autism Coverage Reimbursement Human action and encourage carriers to provide coverage for the diagnosis and handling of autism spectrum disorders. The act also outlines the procedure by which carriers and tertiary-party administrators tin can seek reimbursement for the coverage of autism spectrum disorders. |
| Minnesota | Minn. Stat. § 256B.0949 (2013) provides coverage for Early Intensive Developmental and Behavioral Intervention services when medically necessary for children up to historic period 21 on medical assistance with autism spectrum disorder and related conditions. Minn. Stat. § 62A.3094 (2020) requires all health plans issued to a large employer to provide coverage for the diagnosis, evaluation, multidisciplinary assessment and medically necessary care of children under 18 with autism spectrum disorders. Handling includes speech therapy, occupational therapy, concrete therapy, medications, and neurodevelopmental and behavioral health treatments and direction. |
| Mississippi | Miss. Code Ann. § 83-nine-26 (2015) requires a wellness insurance policy to provide coverage for screening, diagnosis and treatment of autism spectrum disorder. Treatment includes but is not express to behavioral health treatment, pharmacy care, psychiatric intendance, psychological intendance and therapeutic care. Licensed speech-linguistic communication pathologists must provide therapeutic care. |
| Missouri | Mo. Rev. Stat. § 376.1224 (2010) requires all group health benefit plans to provide coverage for the diagnosis and handling of autism spectrum disorders. Coverage is limited to medically necessary treatment that is ordered by the insured'southward treating doctor or psychologist in accordance with a treatment plan. Treatment for autism spectrum disorder is defined to include psychiatric, psychological, habilitative or rehabilitative care, applied beliefs analysis, therapeutic care and pharmacy care. Coverage for practical beliefs assay is bailiwick to a maximum benefit of $40,000 per year for individuals through eighteen years of age. However, this limit may be exceeded, with approval by the health do good plan, if the applied beliefs assay services are medically necessary for an individual. The health benefit programme may not place limits on the number of visits an individual makes to an autism service provider. |
| Montana | Mont. Code Ann. § 33-22-515 (2009) requires group disability policies, certificates of insurance and membership contracts to provide coverage for the diagnosis and treatment of autism spectrum disorders for a covered child 18 years of historic period or younger. Coverage must include habilitative or rehabilitative care, medications, psychiatric or psychological intendance and therapeutic care. Coverage for treatment of autism spectrum disorders may be express to a maximum benefit of $50,000 per year for a child viii years of historic period and younger and $20,000 per yr for a child 9 years of age through 18 years of historic period. |
| Nebraska | Neb. Rev. Stat. § 44-vii,106 (2014) requires any individual or group sickness and accident insurance policy or subscriber contract; whatever hospital, medical or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-do good coverage; and whatever self-funded employee benefit plan to the extent not preempted by federal law, to provide coverage for the screening, diagnosis, and treatment of an autism spectrum disorder in an individual nether 21 years of age. Treatment includes behavioral health treatment, pharmacy intendance, psychiatric care, psychological intendance and therapeutic intendance. Neb. Rev. Stat. § 68-966 (2007) requires the department of wellness to employ for a waiver under the medical assistance plan to provide medical assistance for children diagnosed with autism spectrum disorder. |
| Nevada | Nev. Rev. Stat. §287.0276, § 689A.0435, § 689B.0335, § 689C.1655, § 695C.1717, § 695G.1645 crave individual and grouping health do good plans, wellness care plans issued by a managed care organization, a health maintenance organization and a local governmental bureau to provide the option of coverage for screening, diagnosis and handling of autism spectrum disorders for persons covered by the policy nether the historic period of xviii, or if enrolled in high school, until the person reaches the age of 22. Treatment of autism spectrum disorders must be identified in a treatment plan and may include medically necessary habilitative or rehabilitative care, prescription intendance, psychiatric care, psychological care or behavior therapy. |
| New Hampshire | N.H. Rev. Stat. Ann. § 417-Eastward:1 (1994) requires specified insurers that provide benefits for disease or sickness to provide benefits for treatment and diagnosis of certain biologically based mental illness, including pervasive developmental disorder or autism, nether the same terms and atmospheric condition and which are no less extensive than the coverage provided for any other type of health care for physical illness. N.H. Rev. Stat. Ann. § 417-E:2 (2010) defines the treatment of a pervasive developmental disorder or autism to include professional services and handling programs, including applied behavioral analysis, prescribed pharmaceuticals (subject to the terms and conditions of the policy), directly or consultative services provided by specified licensed professionals, and services provided by licensed oral communication, occupational or physical therapists. The policy, contract or certificate may limit coverage for applied beliefs analysis to $36,000 per twelvemonth for children 0 to 12 years of age and $27,000 from ages 13 to 21. |
| New Bailiwick of jersey | Northward.J. Rev. Stat. § 17:48-6ii, § 17:48A-7ff, § 17:48E-35.33, § 17B:26-2.1cc, § 17B:27-46.1ii, § 17B:27A-7.xvi, § 17B:27A-19.20, § 26:2J-4.34, § 52:14-17.29p and § 52:14-17.46.6b require specified health insurance policies and health do good plans to provide coverage for expenses incurred in screening and diagnosing autism or another developmental disability. When the covered person's primary diagnosis is autism or some other developmental inability, coverage must be provided for expenses incurred for medically necessary occupational therapy, physical therapy and speech therapy, as prescribed through a treatment program. When the covered person is under 21 years of age, and the person'southward primary diagnosis is autism, coverage must be provided for expenses incurred for medically necessary behavioral interventions based on the principles of applied behavioral analysis and related programs, as prescribed through a treatment plan. N.J. Rev. Stat. § 17:48-6v, § 17:48A-7u, § 17:48E-35.twenty, § 17B:26-2.1s, § 17B:27-46.1v, § 17B:27A-seven.5, § 17B:27A-19.7 and § 26:2J-4.20 require specified insurers that provide infirmary or medical expense benefits to provide coverage for mental wellness conditions, including pervasive developmental disorder or autism, under the same terms and conditions equally provided for whatever other sickness under contract. |
| New Mexico | N.M. Stat. Ann. § 59A-22-49, § 59A-23-7.ix, § 59A-46-50 and § 59A-47-45 (2009) require specified insurance policies, health care plans, certificates of health insurance or contracts to provide coverage to an eligible individual for well-infant and well-child screening for diagnosis and treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy and applied behavioral analysis. |
| New York | N.Y. Insurance Law § 3216, § 3221 and § 4303 require specified policies and contracts that provide coverage for hospital or surgical coverage to encompass the screening, diagnosis and treatment of autism spectrum disorder. The law also requires every policy that provides medico services, medical, major medical or similar comprehensive-blazon coverage to provide coverage for the screening, diagnosis and handling of autism spectrum disorder. The law prohibits any limitations on visits that are solely applied to the treatment of autism spectrum disorder. Treatment of autism spectrum disorder is divers to include behavioral health treatments, psychiatric care, psychological care, medical care, therapeutic care and specified pharmacy intendance. |
| North Carolina | N.C. Gen. Stat. §58.iii.192 (2015) requires insurance coverage for the screening, diagnostic testing and treatment of autism spectrum disorder. Coverage includes therapeutic care, which includes services provided past a licensed spoken language-language pathologist. |
| North Dakota | N.D. Cent. Code § 50-06-01.4 (2017) places the department of man services in charge of the administration of medical service programs which includes medical aid for autism services. |
| Ohio | Ohio Rev. Code Ann. § 1751.84 (2017) and § 3923.84 (2017) require individual and group health policies to provide insurance coverage for the screening, diagnostic testing and treatment of autism spectrum disorder. Coverage includes but is not limited to clinical therapeutic intervention, pharmacy care, psychiatric intendance, psychological care and therapeutic intendance. |
| Oklahoma | Okla. Stat. tit. 36, § 6060.xx (2010) requires that all individual and group wellness insurance policies that provide medical and surgical benefits provide the aforementioned coverage and benefits to any individual under the age of 18 who has been diagnosed with an autistic disorder as it would provide coverage and benefits to an individual under the age of eighteen who has not been diagnosed with an autistic disorder. Okla. Stat. tit. 36, § 6060.21 (2016) requires coverage for the screening, diagnosis and treatment of autistic spectrum disorder in individuals less than 9 years of age, or if an individual is not diagnosed or treated until after 3 years of age, coverage shall be provided for at least vi years. The law also provides no coverage limitations for treatment visits and directs the insurance commissioner to annually conform the maximum benefit. Coverage includes merely is not limited to behavioral health handling, pharmacy intendance, psychiatric intendance, psychological care and therapeutic intendance. |
| Oregon | Or. Rev. Stat. § 743A.190 (2007) requires wellness benefit plans to provide coverage for a child under 21 years of age who has been diagnosed with a pervasive developmental disorder. Pervasive developmental disorder includes an autism spectrum disorder. |
| Pennsylvania | Pa. Cons. Stat. tit. 40, § 764h (2008) requires a health insurance policy or regime plan to provide coverage for individuals less than 21 years of age for the diagnostic assessment and treatment of autism spectrum disorders. In that location is a maximum benefit of $36,000 per year and no limit should exist placed on the number of visits. |
| Rhode Island | R.I. Gen. Laws § 27-twenty.eleven-1 et seq. (2011) require specified contracts and policies to provide coverage for autism spectrum disorder. Benefits include coverage for applied beliefs analysis, concrete therapy, speech therapy, occupational therapy, pharmaceutical, psychology and psychiatric services for the treatment of autism spectrum disorder and apply until the covered individual reaches age xv. |
| Due south Carolina | S.C. Code Ann. § 38-71-280 (2007) requires a health insurance plan to provide coverage for the treatment of autism spectrum disorders. Coverage is limited to treatment that is prescribed past the insured's treating medical dr. in accord with a handling plan. To be eligible for coverage, an individual must exist diagnosed with autism spectrum disorder at age eight or younger and be less than 16 years of age. |
| South Dakota | S.D. Codified Laws Ann. § 58-17-157 (2015) requires health coverage for applied behavioral analysis for autism spectrum disorder. The police provides that such coverage may be subject field to pre-authorization, prior blessing and care direction requirements, including limits on the number of individual visits, dollar limits, deductibles, copayments or coinsurance provisions that apply to other medical or surgical services covered under the policy. |
| Tennessee | Tenn. Code Ann. § 56-vii-2367 (2006) requires contracts and policies that provide benefits for neurological disorders to provide benefits and coverage for handling of children less than 12 years of age with autism. The constabulary defines autism spectrum disorder as a neurological disorder. |
| Texas | Tex. Insurance Code § 1355.015 (2007) requires a health benefit programme to provide coverage for screening a child for autism spectrum disorder. Coverage includes all mostly recognized services prescribed in relation to autism spectrum disorder by the enrollee's master care physician in the treatment program recommended by the physician. The constabulary defines "mostly recognized services" to include practical behavior assay, oral communication, occupational and physical therapy; medications or nutritional supplements; and other treatments. This coverage may exist discipline to almanac deductibles, copayments and coinsurance that are consistent with almanac deductibles, copayments and coinsurance required for other coverage under the health benefit programme. |
| Utah | Utah Code Ann. § 31A-22-642 (2014) requires wellness benefit plans to provide coverage for the diagnosis and treatment of autism spectrum disorder for a kid who is at least 2 years old just younger than 10 years one-time. |
| Vermont | Vt. Stat. Ann. Tit. 8 § 4088i (2009) requires wellness insurance plans to provide coverage for the prove-based diagnosis and treatment of early babyhood developmental disorders, including practical behavior analysis for children up to age 21. Early on childhood developmental disorders are defined as a childhood mental or physical impairment or combination of mental and physical impairments that result in functional limitations in major life activities, accompanied by a diagnosis defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Nomenclature of Illness (ICD). The term includes autism spectrum disorders but does non include a learning inability. Treatment of early childhood developmental disorders is defined to include testify-based care and related equipment, behavioral wellness treatment, chemist's shop care, psychiatric intendance, psychological care and therapeutic care. |
| Virginia | Va. Code § 38.two-3418.17 (2011) requires health insurers, health intendance subscription plans and health maintenance organizations to provide coverage for the diagnosis and treatment of autism spectrum disorders in individuals of any age, subject to the annual maximum benefit limitation set. Treatment is defined to include behavioral health treatment, pharmacy care, psychiatric intendance, psychological care, therapeutic care and practical beliefs assay. Coverage is express to an annual maximum benefit of $35,000 for applied behavior analysis unless the insurer elects to provide coverage in a greater amount. Coverage is not field of study to any visit limits. As of Jan i, 2014, to the extent that these required benefits exceed the essential health benefits specified under the Patient Protection and Affordable Care Act, the specific benefits that exceed the essential health benefits are not required of qualified wellness plans that are offered in the land past a health carrier through a health benefit commutation. Va. Lawmaking § 2.2-2818requires the Department of Human Resource Management to establish a programme for providing wellness insurance coverage for state employees and retired country employees. The programme is required to include coverage for biologically based mental illness, including autism. |
| Washington | Wash. Rev. Code § 48.20.420, § 48.21.150, § 48.41.140, § 48.44.200, § 48.44.210 and § 48.46.320 require health insurance contracts for dependent children that are scheduled to end on the attainment of the limiting age in the contract, should not terminate if the child is incapable of cocky-sustaining employment by reason of developmental disability. Wash. Rev. Code § 48.44.341 (2007) requires all wellness plans to cover mental health services the same way they cover medical and surgical services. Mental health services are defined to include disorders listed in the electric current version of DSM-5, and this includes autism spectrum disorder. Launder. Rev. Lawmaking § 48.01.035 (2010) defines a developmental inability equally a disability attributable to autism. Launder. Rev. Code § 74.09.520 (2015) requires universal screening and provider payment for autism and developmental delays. This requirement is subject to the availability of funds. |
| West Virginia | West. Va. Lawmaking § 33-16-3v, §33-24-7k and §33-25A-8j crave specified health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders in individuals from the age of 18 months through 18 years. To be eligible for coverage, the individual must exist diagnosed with autism spectrum disorder at age eight or younger. Coverage includes treatments that are medically necessary and ordered or prescribed by a licensed physician or licensed psychologist, including but not express to applied behavioral analysis. The annual maximum benefit for applied behavioral analysis is $xxx,000 per yr for the first three years after treatment commences and $2,000 per month after three years. |
| Wisconsin | Wis. Stat. § 632.895(12m) and Wis. Stat. § 609.87 requires specified disability insurance policies and cocky-insured health plans to provide coverage for treatment for autism spectrum disorder if the treatment is prescribed by a physician, including specified therapies. The statute defines intensive-level and not-intensive-level services. |
Sources: State Insurance Mandates for Autism Spectrum Disorder, American Spoken communication-Language-Hearing Association (ASHA); State Regulated Health Benefit Plans, Autism Speaks.
Additional Resources
- NCSL's Autism Overview webpage
- National Association of Insurance Commissioners
- Autism Speaks
- Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE)
- Autism and Developmental Disabilities Monitoring (ADDM) Network
- Autism Information Center
What Autism Services Are Covered Under Behavioral Health?,
Source: https://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx
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