Oklahoma Insurance Department announces expanded coverage of autism benefits

Oklahoma Insurance Commissioner Glen Mulready issued a bulletin earlier this month addressing limitations in insurance coverage for applied behavior analysis (ABA) benefits in state-regulated plans. The bulletin announced changes to the state’s mandated age, dollar and hour caps on coverage for autism therapies and treatments, specifically ABA.

The bulletin declares that the state insurance law's maximum benefit of 25 ABA hours per week and no more than $25,000 per year for ABA services are in conflict with federal law and related regulations. The bulletin also announces that the state law's age restrictions on autism-related benefits are considered discriminatory under federal law. This means that an individual in Oklahoma covered by a state-regulated insurance policy does not have to receive an autism diagnosis before age three in order to qualify for coverage of ABA nor does coverage end when the individual turns 10 years old.

The purpose of the Oklahoma Insurance Department’s announcement is to align state law with federal Mental Health Parity law. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended, and the related federal guidance and regulations generally prevent group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. Such prohibited limitations include quantitative treatment limits like age and dollar caps.

To comply with the bulletin, state-regulated policies must change their plan terms by December 31, 2021.

Oklahoma’s autism insurance mandate was initially passed and went into effect in 2016. Since then, caps on coverage have limited families’ ability to provide individuals with autism the care they need. The August 2021 change in policy announced by Commissioner Mulready provides more equitable access to care and will benefit thousands of individuals across the state.