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Summary of 2011 Virginia Autism Insurance Reform Bills

Senate Bill 1062 - Sponsored by Senators Janet D. Howell (District 32); House Bill 2467 - Sponsored by Delegate Tag Greason (District 32) and Delegate Tim Hugo (District 40)
  • Would require applicable health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders for individuals between the ages of 2 and 6 (the bill does not preclude the extension of coverage for individuals age 7 and up)
  • Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary

 

  • Health insurance companies would be required to provide coverage of the following:
  1. Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing, or other testing to determine whether an individual has one or more autism spectrum disorders
  2. Behavioral health treatments- meaning professional, counseling, and guidance services and treatment programs, including applied behavior analysis (ABA), when provided or supervised by a board certified behavior analyst, that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual
  3. Pharmacy care
  4. Psychiatric care
  5. Psychological care
  6. Therapeutic care - meaning services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers
  • Coverage for applied behavior analysis (ABA) is subject to an annual maximum of $35,000 
  • The bill does not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan
  • The bills apply only to state-regulated private insurance plans and the state employee health plan. They do not apply to self-funded insurance plans as these plans are regulated by the federal government under ERISA law