District of Columbia State-Regulated Insurance Coverage

District of Columbia provides meaningful coverage for autism under district-regulated plans.

District of Columbia’s autism insurance bill, B20-0302, was enacted on in 2013. The law became effective January 1, 2014.

To which plan types does the STATE autism insurance law apply?

  • Individual Grandfathered Plans - NO
  • Individual Non-Grandfathered Plans - YES
  • Fully Insured Large Group Plans - NO
  • Fully Insured Small Group Grandfathered Plans - NO
  • Fully Insured Small Group Non-Grandfathered Plans - YES

What services are covered by the law?

  • Habilitative services for the treatment of autism spectrum disorder, including applied behavior analysis

Does the District of Columbia have caps on ABA coverage?

No. There are no age or dollar limits on coverage.

Where can I find more details about the District of Columbia autism insurance law?

 A copy of B20-0302 as enrolled can be found here.

Other comments about the law.

For purposes of the essential health benefits benchmark plan, Council Bill B20-0302 (The Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013) defined “habilitative services” to include “health care services that help a person keep, learn, or improve skills and functioning for daily living, including applied behavioral analysis for the treatment of autism spectrum disorder.”

As such, small group and individual plans sold through the D.C. Exchange must provide coverage for ABA for individuals with autism. This requirement does not apply to grandfathered plans (i.e. plans issued prior to March 23, 2010).

If you have additional questions, please email advocacy@autismspeaks.org

 

Last Updated: December 2019

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