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Maryland To Require Autism Insurance Coverage

April 23, 2014

(April 23, 2014) -- The Maryland Insurance Administration (MIA) has finalized new regulations that will require coverage of autism benefits, including applied behavior analysis (ABA), for many private plans as well as state employees. Related legislation that would establish a state licensing procedure for ABA providers, meanwhile, is headed to Gov. Martin O'Malley in May.

The new requirements will apply to individual, fully funded small and large group plans, the state employee health plan and coverage purchased through Maryland's health insurance marketplace created under the Affordable Care Act. The coverage includes a minimum of 25 hours weekly of ABA up to age six, and then 10 hours weekly through age 18.

In addition, psychological care and speech, occupational and physical therapy for the treatment of autism are covered.

However, the regulations require ABA practitioners to be licensed by the state. Because Maryland has no license, legislation was moved through the legislature to create the license and will be sent to the Governor next month. Autism Speaks and other advocacy organizations had urged the state to accept professional certification to speed up the process, but MIA insisted on the need for a state license.

Rather than require autism insurance coverage through legislation, the Maryland Legislature in 2012 chose to create a task force to clarify the state's existing habilitative services statute to provide autism coverage. After a year of study, MIA first proposed regulations in September 2013, then issued a new proposal this year which ultimately was finalized.

Autism Speaks, Pathfinders for Autism and the Maryland Association of Behavior Analysts will host a series of information session in May to familiarize families and providers with the new regulations. Learn more here.