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Summary of the 2011 Arkansas Autism Insurance Insurance Reform Law

March 04, 2011

The law:

  • Requires health insurance companies to provide coverage of the screening, diagnosis and treatment of autism spectrum disorders
  • Imposes no cap on the number of visits
  • Requires that coverage not be subject to dollar limits, deductibles, copayments, or coinsurance or other terms and conditions that are less favorable than those that apply to physical illness generally under the health plan
  • Directs that 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

Requires health insurance companies to provide coverage of:

  • Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, or tests to diagnose whether an individual has an autism spectrum disorders
  • Applied behavior analysis (ABA)
  • Pharmacy care
  • Psychiatric care
    Psychological care
  • Therapeutic care - meaning services provided by licensed speech therapists, occupational therapists, or physical therapists
  • Any care for individuals with autism spectrum disorders that is determined by a licensed physician to be medically necessary and evidence-based treatment for autism spectrum disorders
  • Caps ABA benefits at $50,000 and an age cap of 18 years old
  • 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
  • Applies only to state regulated insurance plans; it does not apply to self-funded insurance plans which are regulated by the federal government under ERISA law

The law took effect October 1, 2011