Oregon State-Regulated Insurance Coverage

Oregon requires meaningful coverage for autism under state-regulated plans.

Oregon’s autism insurance bill, SB 365 was enacted in 2013 and became effective on January 1, 2016, for individual, large and small group 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?

  • Screening and diagnosis
  • Medically necessary treatment for autism spectrum disorder* (e.g. applied behavior analysis)

For the purposes of this law, “treatment for autism spectrum disorder,” includes ABA and “any other mental health or medical services identified in the individualized treatment plan.”

Does Oregon have caps on coverage?

According to Oregon Insurance Division Bulletin INS 2014-2:

The provisions of SB 365 that establish quantitative standards—the 25-hour per week coverage standard and the nine-year old age standard—are floors, not limitations on ABA coverage. As floors these provisions do not violate the MHPAEA. If applied as limits, these provisions would violate MHPAEA and its regulations, unless the insurer imposed the same limits as the predominant treatment limitation on substantially all of its medical or surgical outpatient coverage.

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.  Learn more here.

Where can I find more details about the Oregon autism insurance law?

 A copy of SB 365 as enrolled can be found here.  A copy of the Oregon Department of Insurance Bulletin that clarifies coverage can be found here

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

 

Last Updated: December 2019

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