Maryland State-Regulated Insurance Coverage
Maryland requires meaningful coverage for autism under state-regulated plans.
To which plan types does the STATE autism insurance law apply?
- Individual Plans - YES
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Plans - YES
What services are covered by law?
- Behavioral health treatment, including applied behavior analysis (ABA). ABA may not be denied on the assertion that it is “experimental” or “investigational.”
- Psychological care, including direct or consultative services and psychotherapy.
- Speech, occupational and physical therapy
Does Maryland have caps on ABA coverage?
No. According to the Maryland Insurance Administration, the regulations do not establish caps or limits, but instead establish a floor for coverage, that carriers may not deny based solely on the number of hours of habilitative services prescribed, which differs depending on the age of the child, consistent with the Autism Technical Advisory Group’s report.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. This includes quantitative treatment limits like age and dollar caps.
Where can I find more details about the State autism insurance law?
A copy of the regulatory changes related to habilitative services for autism can be found here.
If you have additional questions, please email firstname.lastname@example.org.
Last Updated: December 2019