- Amends current mental health parity law to require health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorders
In order to receive coverage, treatment must be prescribed, provided, or ordered for an individual diagnosed with a pervasive developmental disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary
Covered treatments include:
- Professional services and treatment programs, including applied behavioral analysis, necessary to produce socially significant improvements in human behavior or to prevent loss of attained skill or function. To be eligible for coverage, applied behavior analysis must be provided by a person professionally certified by the national Behavior Analyst Certification Board or performed under the supervision of a person professionally certified by the national Behavior Analyst Certification Board.
- Prescribed pharmaceuticals subject to the same terms and conditions of the policy as other prescribed pharmaceuticals.
- Direct or consultative services provided by a licensed professional including a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, or licensed clinical social worker; and
Services provided by a licensed speech therapist, licensed occupational therapist, or licensed physical therapist
- Coverage shall not be denied on the basis that services are habilitative in nature
- There is a maximum benefit of $36,000 for children ages 0 to 12, and a maximum benefit of $27,000 for children ages 13 to 21
- An insurer may require a treatment plan stating that the treatment is medically necessary and is consistent with nationally recognized treatment standards
- The new law does not replace existing services
- The law applies only to state regulated insurance plans. It does not apply to self-funded insurance plans, as these plans are regulated by the federal government under ERISA law