Pennsylvania removes insurance barriers for autism spectrum disorder

Unnecessary barriers to insurance coverage of autism benefits have historically persisted in Pennsylvania despite federal law and state precedent for the coverage of autism services. Starting in 2024, over 55,000 Pennsylvanians with autism will now benefit from additional state protections.

Pennsylvania Governor Josh Shapiro and Insurance Commissioner Michael Humphreys recently announced a directive requiring all state-regulated commercial insurers to treat autism spectrum disorder (ASD) as a mental health condition and cover autism treatment and services in compliance with federal and state mental health parity laws. This announcement followed a Pennsylvania Insurance Department notice published on November 4, 2023, in the Pennsylvania Bulletin.

This notice requires all commercial insurers offering comprehensive health insurance in the Commonwealth to

• meet their obligations under state law to provide coverage for autism benefits;
• treat autism as a mental health condition and thus be accountable to mental health parity laws, such as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and PA Act 14; and
• comply with mental health parity requirements by January 1, 2024.

Autism Speaks is grateful for Governor Shapiro and Insurance Commissioner Humphrey’s commitment to mental health parity and ensuring that commercial insurers will cover autism services fairly and consistently. MHPAEA and related federal guidance and regulations generally prevent health issuers and group health plans that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than medical/surgical benefits. Such prohibited limitations include quantitative treatment limits like age and dollar caps. The state’s enforcement of these parity standards will help reduce barriers to health care services for autistic people who rely on commercial coverage of autism benefits and treatment.

For over a decade, Autism Speaks has been advocating that all Pennsylvanians with autism are afforded these protections of mental health parity. Most recently, we submitted a public comment to the Pennsylvania Insurance Department requesting that they add applied behavior analysis (ABA), one of the most common and effective behavioral health treatments available for autism, to the Commonwealth’s Essential Health Benefits Benchmark Plan. In our comment, we urged the administration to view autism spectrum disorder as a mental health condition, which is recognized as one in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).

If you are looking for autism services, our Autism Response Team members are available to provide personalized information and resources to autistic individuals, families, service providers, and the community. If you have concerns about the enforcement of coverage of autism services under your health insurer, please reach out to us at advocacy@autismspeaks.org.

Additional Resources:

• Governor Josh Shapiro’s Press Release
• Health Insurance Coverage of Autism
  • Pennsylvania State-Regulated Insurance Coverage
  • Medicaid Coverage of Autism

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