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North Carolina Gov. McCrory signs autism insurance reform legislation

October 15, 2015

Charlotte, NC − Governor Pat McCrory was joined today by North Carolina autism advocates for an autism insurance bill-signing ceremony. Earlier this month, the North Carolina General Assembly approved legislation to require certain health plans to cover the screening, diagnosis and treatment of autism.

S.676 was sponsored by Senators Tom Apodaca and Joyce Krawiec. The insurance mandate becomes effective July 1, 2016 and applies to insurance contracts renewed on or after that date.

“Today is a major victory for the autism community as the state of North Carolina becomes the 43rd state to require insurance carriers to provide individuals with autism the care they deserve,” said Lorri Unumb, Esq., Vice President, State Government Affairs for Autism Speaks. “We are grateful for the hard work of Senator Apodaca and Representative Chuck McGrady to bring autism insurance reform to North Carolina and for Governor McCrory for enacting these important reforms and for his ongoing commitment to the autism community.”

Treatment coverage will include the following, when determined to be medically necessary: therapeutic care (including OT, PT and ST); psychiatric care; psychological care; pharmacy care; and adaptive behavior treatment, which includes Applied Behavior Analysis and may be limited to $40,000 per year (adjustable for inflation) and age 18. 

"What a long, challenging journey it has been, but today, autism families across North Carolina celebrate becoming the 43rd state to pass autism insurance reform. I am thrilled for those who today have a little more hope than they did yesterday,” said Shea Capps an Autism Speaks advocate from North Carolina. “Today we thank those who have advocated and worked tirelessly on behalf of every child with autism in our state. On behalf of my son and all other North Carolina children with autism, North Carolina says thank you from the bottom of our hearts."

The health plans subject to the bill include large group plans; grandfathered plans (plans sold to individuals and small groups that have been in effect and essentially unchanged since March of 2010); and transitional or “grandmothered” plans (plans sold to individuals and small groups that are not grandfathered but were in effect prior to 2014.)

With the passage of S.676, several segments of the market are now required to cover treatment for autism.  The State Employee Health Plan, covering more than 600,000 individuals, added ABA coverage in January of this year. S.676 requires coverage in certain parts of the commercial market, reaching approximately 600,000 individuals.  And progress in the self-funded market has seen the addition of ABA coverage in several NC-based corporations, including Bank of America and other noteworthy companies that will be announcing ABA coverage soon for 2016.  

Prior to passage, Senate Bill 676 had remained in the House Rules Committee for several months while parties discussed the mental health parity implications of the bill.  In the end, S.676 still removes autism from the definition of “mental illness” in the state’s mental health parity law, but it also specifically applies the standards of the federal mental health parity law to the coverage.

Earlier this year, North Carolina enacted House Bill 556, ABLE legislation that allows families to set up tax-exempt 529A savings accounts for disability-related expenses. Read more here.

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