Summary of Delaware 2011 Autism Insurance Reform Bill

Senate Bill 22 - Sponsored by Senators Liane Sorenson (R-6) and Catherine Cloutier (R-5) Cosponsored by Representative S. Quinton Johnson (D-8)

The bill would:

 

  • Require health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders for individuals age 21 and younger
  • Direct that coverage of treatments be provided when prescribed or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary.

Require health insurance companies to provide coverage of the following:

  • Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders
  • Behavioral health treatment - meaning professional counseling, guidance services, and treatment programs, including applied behavior analysis (ABA), that are necessary to develop, maintain, and restore, to the maximum possible extent practicable, an the functioning of an individual
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care - meaning services provided by speech, occupational, or physical therapists, or an aide or assistant under their supervision
  • Any care for individuals with autism spectrum disorders that is determined by the Secretary of the Department of Health and Social Services, based upon their review of best practices and/or evidence-based research, to be medically necessary
     
  • Allow coverage for Applied Behavior Analysis (ABA) up to an annual maximum of $36,000, but set no limits on the number of visits to an ABA provider
  • Impose no dollar or number of visit limitations on other covered treatments unrelated to ABA
  • 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
  • Apply only to state-regulated insurance plans; it would not apply to self-funded insurance plans which are regulated by the federal government under ERISA law
  • Take effect 120 days after enactment