Arkansas State-Regulated Insurance Coverage
Arkansas requires meaningful coverage for autism under state-regulated plans.
To which plan type does the STATE autism insurance law apply?
- Individual Plans subject to ACA – YES
- Individual Plans specifically exempt from the ACA (often called Grandfathered Plans) – NO
- Fully Insured Small Group Plans – YES
- Fully Insured Large Group Plans – YES
What services are covered by the law?
- Diagnostic assessments
- Applied Behavior Analysis (ABA)
- Pharmacy Care
- Psychiatric Care
- Psychological Care
- Therapeutic Care (speech therapy, occupational therapy and physical therapy)
- Equipment determined necessary to provide evidence-based treatment
- Any medically necessary and evidence-based care (as determined by a licensed physician)
Does the Arkansas autism insurance law allow caps on ABA coverage?
Yes, but it’s complicated. The law states that coverage can be limited to individuals under 18 years of age and that a $50,000 annual cap is permitted for ABA benefits. However, the Consumer Services division of the Arkansas Insurance Department can help consumers if they see age or dollar caps for ABA in their plan documents or if the age or dollar caps for ABA are imposed by insurers.
- Whether or not these caps are included in a health insurance plan is specific to each type of plan, and such limitations are required to be disclosed in the plan document. Most often, there is a specific section of the plan that describes the plan’s autism/ABA benefit. A consumer can contact plan representatives to learn where to find autism-related information in the plan document.
- There are now laws that challenge the validity of the age and dollar cap limitations. These are known as “mental health parity” laws, and they generally apply to services used to treat autism.
- Mental health parity laws prevent group health plans [and health insurance issuers] that provide mental health or substance-use disorder (MH/SUD) benefits from imposing less favorable limitations on MH/SUD benefits than on medical/surgical benefits. This means that quantitative treatment limits like age and dollar caps are not permitted in most cases.
- To learn about the federal mental health parity law, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), visit here.
- To learn about state mental health parity laws, the nonprofit Kennedy Forum sponsors a web-based tool, Parity Track, that provides further details on individual state laws, regulations, pending bills and implementation. (Autism Speaks is not responsible for the contents or opinions contained on third-party websites.)