Applied behavior analysis (ABA) therapy has grown to be seen by most industry experts as the gold standard for treating autism spectrum disorder (ASD) and addressing other behavioral issues. ABA therapists along with a wide range of advocacy groups have worked tirelessly with state and federal legislators in support of autism insurance reform.
This has helped make ABA services easily accessible to families who have children with autism spectrum disorder. To that point, many state legislators have moved to classify ABA as a medically necessary form of therapy. This further ensures that medical insurance providers will expressly be required to cover the cost of ABA therapy.
However, many insurance laws and public health programs are administered at the state level. This means that restrictions and available coverage can vary widely from state to state. This can include critical factors such as visitation limits, and even the ABA qualifications a provider must hold in order for their services to be fully reimbursed.
To help you understand the potential terms, restrictions, and access to ABA therapy in your state, we’ve constructed the following guide. These are at-a-glance information nuggets that also include the listing of the state regulation governing them.
Alabama—2012 Alabama Act, Act 298
http://alisondb.legislature.state.al.us/ALISON/SearchableInstruments/2017RS/PrintFiles/HB284-enr.pdf
The state of Alabama requires a health benefit plan to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder for individuals age eighteen or under. This includes policies and contracts to employers with at least 51 employees for at least 50 percent of their working days for the preceding calendar year.
The coverage is limited to treatments that are prescribed by the insured’s licensed physician or licensed psychologist. It includes behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care.
Alaska—2012 Alaska Session Laws, Chapter 63
http://www.legis.state.ak.us/PDF/27/Bills/SB0074Z.PDF
In the state of Alaska insurers to provide coverage for the diagnosis and treatment of autism spectrum disorder for individuals under 21. Covered treatment includes medically necessary pharmacy care, psychiatric care, psychological care, habilitative or rehabilitative care, and therapeutic care. There are no limits on the number of visits an individual may make to an autism services provider.
Arizona—2008 Arizona Session Laws, Chapter 4
http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/20/00826-04.htm&Title=20&DocType=ARS
The state of Arizona expressly requires policies issued by certain health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorder. These treatments include diagnosis, assessment, and services.
However, speech-language services are not clearly defined in the statute. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.
Arkansas—2011 Arkansas Acts, Act 196
http://www.arkleg.state.ar.us/assembly/2011/2011R/Acts/Act196.pdf
Arkansas mandates that health benefit plans must provide for coverage for the diagnosis and treatment of autism spectrum disorder. Treatment includes:
Applied behavior analysis when provided by or supervised by a Board Certified Behavior Analyst.
- Pharmacy care
- Psychiatric care Psychological care
- Therapeutic care (which includes services provided by licensed speech therapists, occupational therapists, or physical therapists)
- Equipment determined necessary to provide evidence-based treatment; provided such treatments determined by a licensed physician to be medically necessary and evidence-based.
The practitioner must be a board-certified behavior analyst (BCBA) or supervised by a BCBA and licensed by either Arkansas’s Division of Developmental Disabilities Services of the Department of Human Services or the Arkansas Board of Examiners in Counseling
California—2011 California Stats, Chapter 650
http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20111009_chaptered.html
In California all health care service plan contract that provides hospital, medical, or surgical coverage to provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012.
The spectrum of covered treatments includes:
- Professional services
- Treatment programs
Applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and includes speech-language pathology and audiology.
Colorado—2009 Colorado Session Laws, Chapter 391; SB 244 of 2009
http://www.lexisnexis.com/hottopics/Colorado/
The state of Colorado mandates that all health benefit plans must provide coverage for the assessment, diagnosis, and treatment of autism spectrum disorders for a child.
Treatments include:
- Evaluation and assessment services
- Behavior training
- Behavior management
- Applied behavior analysis
- Habilitative or rehabilitative care
- Occupational therapy
- Physical therapy
- Speech therapy
Though the practitioner must be a licensed physician, psychologist, or psychiatrist, hold a doctoral degree in behavioral health science and have one year of behavioral therapy experience, or hold the board-certified behavior analyst certification (BCBA), or hold the board-certified assistant behavior analyst certification and practice under the supervision of a BCBA
Connecticut—Connecticut Insurance Department 2014 Bulletin
http://www.cga.ct.gov/2009/ACT/PA/2009PA-00115-R00SB-00301-PA.htm
Requires each group health insurance policy to provide coverage for the diagnosis and treatment of autism spectrum disorders. Treatments include
- Behavioral therapy
- Prescription drugs
- Direct psychiatric or consultative services provided by a licensed psychiatrist.
- Direct psychological or consultative services provided by a licensed psychologist.
- Physical therapy provided by a licensed physical therapist.
- Speech and language pathology services provided by a licensed speech and language pathologist
Occupational therapy provided by a licensed occupational therapist, provided such treatments are (1) medically necessary, and (2) identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker for an insured who is diagnosed with an autism spectrum disorder.
The practitioner must be a board-certified behavior analyst (BCBA), a licensed psychologist, a licensed physician, or supervised by a BCBA
Delaware—2012 Delaware Laws, Senate Bill 22
http://www.legis.delaware.gov/LIS/lis146.nsf/vwLegislation/SB+22/$file/legis.html?open
Delaware requires all health benefit plans to provide coverage for the screening and diagnosis of autism spectrum disorders and the treatment of autism spectrum disorders in individuals less than 21 years of age.
Treatment includes behavioral health treatment; pharmacy care; psychiatric care; psychological care; therapeutic care (including services provided by a speech, occupational, or physical therapists or an aide or assistant under their supervision); items and equipment necessary to provide, receive, or advance in the above-listed services. This includes those necessary for applied behavioral analysis; and any care for individuals with ASD that is determined by the Secretary of the Department of Health and Social Services, based upon their review of best practices and/or evidence-based research, to be medically necessary.
Coverage under this section cannot be denied on the basis that the treatment is habilitative or nonrestorative in nature.
The practitioner must be a board-certified behavior analyst or working under the supervision of a BCBA
District of Columbia—2013 District of Columbia B20-0302
http://lims.dccouncil.us/Download/29396/B20-0240-SignedAct.pdf
Requires the essential health benefits benchmark plan to include habilitative services, including applied behavioral analysis for the treatment of autism spectrum disorder.
Applies to specified group health insurance policies and individual plans.
Coverage limit is the same as for other treatments/therapies.
No visitation limits, and no age limits.
Practitioner must be nationally certified as a board-certified behavior analyst (BCBA)
Florida—Florida Laws, Chapter 30: SB 2654 of 2008; 2016 Florida Bill 0221
http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=627.6686&URL=0600-0699/0627/Sections/0627.6686.html
Applies to all health insurance plans and health maintenance contracts, and includes coverage for autism spectrum disorders, as well as Down Syndrome Coverage, is limited to $36,000 annually and $200,000 in total lifetime benefits
No visitation limits
No age restriction
Practitioner must be nationally certified as a board-certified behavior analyst (BCBA)
Georgia—2015 Georgia House Bill 429
http://www.legis.ga.gov/Legislation/20152016/153798.pdf
The state of Georgia requires accident and sickness contracts, policies or benefit plans to provide for medically necessary coverage for autism spectrum disorder for children under six years of age. Coverage includes therapy services provided by a licensed or certified speech therapist or speech-language pathologist.
Applies to state-regulated private insurance companies’ group policies.
Coverage is limited to $30,000 per year.
With no visitation limits
Applying to individuals aged six and under
Practitioner must be nationally certified as a board-certified behavior analyst (BCBA) or working under the supervision of a BCBA
Hawaii—2015 Hawaii Laws, Senate Bill 791
http://www.capitol.hawaii.gov/session2015/bills/SB791_CD1_.pdf
The state of Hawaii mandates individual or group accident and health or sickness insurance policies provide coverage for individuals under fourteen for the diagnosis and treatment of autism. Coverage includes behavioral health treatment, pharmacy care, psychiatric care, psychological care and therapeutic care, including therapy services provided by a licensed speech pathologist.
Coverage applies to all state-regulated health insurance plans and is limited to $25,000 per year.
No visitation limits.
The practitioner must be a board-certified behavior analyst (BCBA) and licensed through Hawaii’s Department of Commerce and Consumer Affairs Professional and Vocational Licensing Division
Idaho
Idaho’s insurance laws do not require insurers to coverage for ABA therapy. Though there is hope in the industry for a change.
Illinois—Illinois Statute 215 ILCS
http://www.ilga.gov/legislation/ilcs/ilcs4.asp?DocName=021500050HArt%2E+XX&ActID=1249&ChapAct=215%26nbsp%3BILCS%26nbsp%3B5%2F&ChapterID=22&ChapterName=INSURANCE&SectionID=52237&SeqStart=94000000&SeqEnd=106400000&ActName=Illinois+Insurance+Code%2E
The state of Illinois has some of the most expansive coverage laws. They require certain health insurers to provide individuals under 21 years of age coverage for the diagnosis of autism spectrum disorders and for the treatment of autism spectrum disorders.
Treatment includes:
Care prescribed, provided, or ordered for an individual diagnosed with an autism spectrum disorder by (A) a physician licensed to practice medicine in all its branches, or (B) a certified, registered, or licensed healthcare professional with expertise in treating effects of autism spectrum disorders. When the care is determined to be medically necessary and ordered by a physician licensed to practice medicine in all its branches; psychiatric care, meaning direct, consultative, or diagnostic services provided by a licensed psychiatrist; psychological care, meaning direct or consultative services provided by a licensed psychologist; habilitative or rehabilitative care, meaning professional, counseling, and guidance services and treatment programs, including applied behavior analysis, that are intended to develop, maintain, and restore the functioning of an individual; therapeutic care, including behavioral, speech, occupational, and physical therapies. Coverage provided shall be subject to a maximum benefit of $36,000 per year, but shall not be subject to any limits on the number of visits to a service provider.
Practitioner must be a licensed physician or a certified health care professional. Legislation expected to pass in 2017 will require practitioners to hold national certification as board-certified behavior analyst.
Indiana—Indiana Code 27-8-14.2-1
http://www.in.gov/legislative/ic/code/title27/ar8/ch14.2.html
The state of Indiana requires group and individual policies to provide coverage for the treatment of a pervasive developmental disorder of an insured. A pervasive developmental disorder is defined as a neurological condition, including Asperger’s syndrome and autism, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
The coverage required cannot be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the accident and sickness insurance policy.
However, Indiana does not mandate speech-language services in the statute. Coverage is “limited to treatment that is prescribed by the insured’s treating physician in accordance with a treatment plan.”
Iowa—Iowa House File 2531 of 2010
http://search.legis.state.ia.us/nxt/gateway.dll/ic?f=templates&fn=default.htm
In Iowa a group plan must be established for employees of the state providing for third-party payment or prepayment of health, medical, and surgical coverage benefits shall provide coverage benefits to covered individuals under twenty-one years of age for the diagnostic assessment of autism spectrum disorders and for the treatment of autism spectrum disorders.
Approved treatment must be deemed medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative care, and therapeutic care (including services provided by a licensed speech pathologist, licensed occupational therapist, or licensed physical therapist). Coverage shall not exceed thirty-six thousand dollars per year but shall not be subject to any limits on the number of visits to an autism service provider for the treatment of autism spectrum disorders.
Practitioner must be a board-certified behavior analyst (BCBA) or performed by a board-certified assistant behavior analyst under the supervision of a BCBA
Kansas—2014 Kansas House Bill No. 2744
http://kslegislature.org/li/b2011_12/statute/075_000_0000_chapter/075_065_0000_article/075_065_0024_section/075_065_0024_k/
The state of Kansas requires the state employees’ health care commission to provide for the coverage of services for the diagnosis and treatment of autism spectrum disorder in any covered individual whose age is less than 19 years.
The coverage is determined in consultation with the autism services provider and the patient. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is between birth and less than seven years shall not exceed $36,000 per year. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is at least seven years and less than 19 years shall not exceed $27,000 per year.
Kansas also requires any large group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital, and medical service corporation contract, fraternal benefit society, or health maintenance organization which provides coverage for accident and health services and which is delivered, issued for delivery, amended or renewed to provide coverage for the diagnosis and treatment of autism spectrum disorder in any covered individual whose age is less than 12 years.
Unfortunately, speech-language services are not clearly defined in the statute. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.
Practitioner must be a board-certified behavior analyst (BCBA)
Kentucky—Kentucky Revised Statutes 304.17A-142
http://www.lrc.ky.gov/KRS/304-17A/142.PDF
http://www.lrc.ky.gov/KRS/304-17A/143.PDF
The state of Kentucky Requires that a large group health benefit plan and individual and small group market health benefit plans provide coverage for the diagnosis and treatment of autism spectrum disorders. This is broken up into large group health benefit plans as well as individual and small group market health benefit plan
Large Group Health Benefit Plans
Treatment includes medical care; habilitative or rehabilitative care; pharmacy care, if covered by the plan; psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); and applied behavior analysis prescribed or ordered by a licensed health or allied health professional.
Coverage under this section shall be subject to a maximum annual benefit per covered individual as follows: for individuals between the ages of one (1) through their seventh birthday, the maximum annual benefit shall be $50,000 per individual; for individuals between the ages of seven (7) through 21, the maximum benefit shall be $1,000, per month per individual.
Individual & Small Group Market Health Benefit Plans
All health benefit plans in the individual and small group market shall provide coverage for pharmacy care if covered by the plan: psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); applied behavior analysis; habilitative and rehabilitative care. Coverage for autism spectrum disorders shall be subject to $1,000 maximum benefit per month, per covered individual.
The practitioner must be a board-certified behavior analyst licensed by the Kentucky Applied Behavior Analysis Licensing Board or a supervisee working under the supervision of a BCBA or BCaBA.
Louisiana—Louisiana House Bill 771 2012
http://www.legis.state.la.us/lss/lss.asp?doc=507890
The state of Louisiana requires all health coverage plans to provide coverage for the diagnosis and treatment of autism spectrum disorders in individuals less than 21 years of age. Treatment includes: habilitative or rehabilitative care; pharmacy care; psychiatric care; psychological care; therapeutic care (including services provided by licensed or certified speech therapists, occupational therapists, or physical therapists licensed or certified in this state), provided the care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a physician or psychologist who shall be licensed in this state and who shall supervise the provision of such care.
Though coverage is subject to a maximum benefit of $36,000 per year and a lifetime maximum benefit of $144,000. There shall not be any limits on the number of visits an individual may make to an autism services provider.
Practitioner must be licensed or certified by the Louisiana Behavior Analyst Board
Maine—2014 Maine Laws, LD 347
http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec2768.html
http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec2847-T.html
http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec4259.html
The state of main mandates that all individual and group health insurance policies and contracts must provide coverage for autism spectrum disorders for an individual covered under a policy or contract who is 5 years of age or under in accordance with the following.
Treatment includes habilitative or rehabilitative services, including applied behavior analysis or other professional or counseling services; counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker; and therapy services provided by a licensed or certified speech therapist, occupational therapist or physical therapist.
However a practitioner must be a licensed clinical psychologist, or certified through the Behavior Analyst Certification Board or the Association of Professional Behavior Analysts
Maryland—2012 Maryland Insurance Administration Insurance Article 2-109
http://www.lexisnexis.com/hottopics/mdcode/
Maryland requires insurers and nonprofit health service plans as well as health maintenance organizations to provide coverage for habilitative services to children under the age of 19 years coverage who have a congenital or genetic birth defect, this includes autism.
Applies to all insurers, health benefit plans, nonprofit health service plans, and health maintenance organizations in the state
No coverage limits
No visitation limits
Applies to individuals age 19 and under
Practitioner must be a board-certified behavior analyst (BCBA)
Massachusetts—2010 Massachusetts Acts, Chapter 207
http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleIV/Chapter32A/Section25
The state of Massachusetts requires insurance coverage for autism. Treatment includes the following care prescribed, provided or ordered for an individual diagnosed with 1 of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary: habilitative or rehabilitative care; pharmacy care; psychiatric care; psychological care; and therapeutic care, including speech therapy services.
No coverage limits, no visitation limits or age restrictions. Though the practitioner must be a board-certified behavior analyst or supervised by a board-certified behavior analys
Michigan—2012 Michigan Public Acts, Act 100
http://www.legislature.mi.gov/documents/2011-2012/publicact/htm/2012-PA-0099.htm
http://www.legislature.mi.gov/documents/2011-2012/publicact/htm/2012-PA-0100.htm
http://www.legislature.mi.gov/documents/2011-2012/publicact/htm/2012-PA-0101.htm
The state of Michigan requires a health care corporation group or nongroup certificate to provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders. Treatment of autism spectrum disorders prescribed or ordered for an individual diagnosed with 1 of the autism spectrum disorders by a licensed physician or a licensed psychologist includes
Behavioral health treatment
Pharmacy care
Psychiatric care
Psychological care
Therapeutic care from a licensed or certified speech therapist, occupational therapist, physical therapist, or social worker.
Coverage for treatment of autism spectrum disorders may be limited to a member through 18 years of age and may be subject to a maximum annual benefit as follows: (i) For a covered member through 6 years of age, $50,000.00; (ii) For a covered member from 7 years of age through 12 years of age, $40,000.00; and (iii) For a covered member from 13 years of age through 18 years of age, $30,000.00.
Coverage is limited to $50,000 for children up to age six, $40,000 for children ages 7-12, and $30,000 for children ages 13-18. With no visitation limits
Minnesota—2013 Minnesota Law, HF 1233, Article 12
https://www.revisor.mn.gov/laws/?year=2013&type=0&doctype=Chapter&id=108
The state of Minnesota requires all health plans issued to a large employer, the state employee group insurance program must provide coverage for the diagnosis, evaluation, multidisciplinary assessment, and medically necessary care of children under 18 with autism spectrum disorders. Treatment includes speech therapy. Children enrolled in medical assistance will receive early intensive intervention for an autism spectrum disorder diagnosis.
Applies to all state employee health plans, fully insured large group plans, Medicaid, and Minnesota Comprehensive Health Association high-risk plans.
There are no coverage limits, no visitation limits, and applies to individuals 18 years of age and younger.
Mississippi—2015 Mississippi Laws, HB 885
http://billstatus.ls.state.ms.us/documents/2015/pdf/HB/0800-0899/HB0885SG.pdf
The state of Mississippi requires a health insurance policy to provide coverage for screening, diagnosis, and treatment of autism spectrum disorder. Treatment means evidence-based care prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including, but not limited to: behavioral health treatment; pharmacy care; psychiatric care; psychological care; and therapeutic care. Therapeutic care must be provided by licensed speech-language pathologists.
Practitioner must be a board-certified behavior analyst or supervised by a board-certified behavior analyst.
Missouri—Missouri House Bill 1311
http://www.moga.mo.gov/statutes/C300-399/3760001224.HTM
The state of Missouri mandates that all group health benefit plans that are delivered, issued for delivery, continued, or renewed on or after January 1, 2011, to provide coverage for the diagnosis and treatment of autism spectrum disorders to the extent that such diagnosis and treatment is not already covered by the health benefit plan.
Treatment for autism spectrum disorders, care prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or licensed psychologist, include: psychiatric care; psychological care; habilitative or rehabilitative care, including applied behavior analysis therapy; therapeutic care including services provided by licensed speech therapists, occupational therapists, or physical therapists, and pharmacy care.
Though coverage is limited to $40,00 per year except with approval by the health benefit plan, to be annually adjusted each year. There are no visitation limits, and coverage applies to all people 18 years of age or younger.
Montana—2009 Montana Laws, Chapter 359, SB 234 of 2009
http://data.opi.mt.gov/bills/mca/33/22/33-22-515.htm
The state of Montana requires each group disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for diagnosis and treatment of autism spectrum disorders for a covered child 18 years of age or younger.
Treatment includes habilitative or rehabilitative care that is prescribed, provided, or ordered by a licensed physician or licensed psychologist, including but not limited to professional, counseling, and guidance services and treatment programs that are medically necessary to develop and restore, to the maximum extent practicable, the functioning of the covered child; medications prescribed by a physician; psychiatric or psychological care; and therapeutic care that is provided by a speech-language pathologist, audiologist, occupational therapist, or physical therapist licensed in this state. Coverage for treatment of autism spectrum disorders under this section may be limited to a maximum benefit of:
$50,000 a year for a child 8 years of age or younger; and
$20,000 a year for a child 9 years of age through 18 years of ag
Practitioners must be a board-certified behavior analyst or be certified by the department of public health and human services as a family support specialist with an autism endorsement.
Nebraska—2014 Nebraska Laws, LB 254; 2016 Medicaid Mandate
http://nebraskalegislature.gov/laws/statutes.php?statute=44-7,106
In Nebraska all individual or group sickness and accident insurance policy or subscriber contracts delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and any self-funded employee benefit plan to the extent not preempted by federal law.
This includes any such plan provided for employees of the State of Nebraska, to coverage for the screening, diagnosis, and treatment of an autism spectrum disorder in an individual under twenty-one years of age.
Treatment includes:
Behavioral health treatment
Pharmacy care
Psychiatric care
Psychological care
Therapeutic care provided by a licensed speech-language pathologist, occupational therapist, or physical therapist.
There are no coverage limits and visitation is limited to 25 hours a week, for individuals 20 years old and younger.
Practitioner must be a licensed psychologist, or a behavior analyst certified by a national board such as the Behavior Analyst Certification Board
Nevada—2015 Nevada A.B. 6
http://www.leg.state.nv.us/nrs/NRS-689A.html#NRS689ASec0435
The state of Nevada requires an individual health benefit plan to provide an option of coverage for screening for and diagnosis of autism spectrum disorders and for treatment of autism spectrum disorders for persons covered by the policy under the age of 18 or if enrolled in high school until the person reaches the age of 22.
The treatment of autism spectrum disorder must be identified in a treatment plan and may include medically necessary habilitative or rehabilitative care, prescription care, psychiatric care, psychological care, behavior therapy, or therapeutic care.
Coverage is limited to $72,000 per year with no visitation limits. Coverage applies to individuals 18 years old and younger or 21 if enrolled in high school.
Practitioner must be a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst, or certified autism behavior interventionist.
New Hampshire—2010 New Hampshire Laws, House Bill 569, Chapter 363
http://www.gencourt.state.nh.us/rsa/html/XXXVII/417-E/417-E-2.htm
In the state of New Hampshire insurance coverage for diagnosis and treatment of pervasive developmental disorders or autism for all group policies, contracts, is required.
Treatment includes professional services and treatment programs, including applied behavioral analysis; prescribed pharmaceuticals subject to the same terms and conditions of the policy as other prescribed pharmaceuticals; direct or consultative services provided by a licensed professional including a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, or licensed clinical social worker; and Services provided by a licensed speech therapist, licensed occupational therapist, or licensed physical therapist.
Coverage is limited to $36,000 per year for children up to 12 years and $27,00 for children ages 13-21
There are no visitation limits, but any practitioner must be a board-certified behavior analyst or supervised by a BCBA
New Jersey—2009 New Jersey Laws, Chapter 115, AB 2238
http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=232405&depth=2&expandheadings=off&headingswithhits=on&infobase=statutes.nfo&softpage=TOC_Frame_Pg42
New Jersey requires specified health insurance policies and health benefit plans to provide benefits for the treatment of autism or other developmental disability. Coverage must include medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan. The maximum benefit amount for a covered person in any calendar year through 2012 shall be $37,080.
There are no coverage limits and no visitation limits. Coverage applies to individuals 21 years old and younger.
Practitioner must be a board-certified behavior analyst (BCBA) or supervised by a BCBA
New Mexico—2009 New Mexico Laws, Chapter 74, SB 39 of 2009
http://public.nmcompcomm.us/nmpublic/gateway.dll/?f=templates&fn=default.htm
In New Mexico specified health insurance policy, health care plan or certificate of health insurance shall provide coverage to an eligible individual who is nineteen years of age or younger, or an eligible individual who is twenty-two years of age or younger and is enrolled in high school. This includes
Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder; and
Treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy and applied behavioral analysis.
Coverage shall be limited to $36,000 annually and shall not exceed $200,000 in total lifetime benefits. Though there are no visitation limits.
The practitioner must be licensed or certified.
New York—New York Autism Insurance Reform Law
http://public.leginfo.state.ny.us/LAWSSEAF.cgi?QUERYTYPE=LAWS+&QUERYDATA=$$ISC3216$$@TXISC03216+&LIST=LAW+&BROWSER=EXPLORER+&TOKEN=48667411+&TARGET=VIEWhttp://assembly.state.ny.us/leg/?default_fld=&bn=A06305&term=2011&Summary=Y&Actions=Y&Votes=Y&Memo=Y&Text=Y
The state of New York mandates that every policy which provides physician services, medical, major medical or similar comprehensive-type coverage to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. Coverage includes therapeutic care, which is habilitative or nonrestorative, provided by a licensed or certified speech therapist.
Coverage is limited to $45,000 annually, with no age or visitation limits.
The practitioner must be licensed through the New York State Education Department (NYSED)
North Carolina—2015 North Carolina Laws, SB 676
http://www.ncleg.net/Sessions/2015/Bills/Senate/PDF/S676v4.pdf
The State of North Carolina requires all health benefit plans to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. Coverage includes therapeutic care, which includes services provided by a licensed speech-language pathologist. Though it is limited to $40,000 annually, and there are no visitation limits
Practitioner must be licensed as a psychologist by the North Carolina Psychology Board or practicing under the supervision of a licensed psychologist.
North Dakota—North Dakota State Plan for Autism Spectrum Disorders and Preventative Care
https://www.nd.gov/dhs/info/pubs/docs/medicaid/state-plan-amend-for-autism-spectrum-disorders-preventive-services-06-20-16.pdf
The state of North Dakota applies to Medicaid plans in the state with no coverage limits, no visitation limits for individuals ages 21 and younger.
Practitioner must be licensed by the North Dakota State Board of Psychologist Examiners (NDSBPE)
Ohio—Governor’s Insurance Policy Directive, 2012
http://insurance.ohio.gov/Company/Documents/EssentialHealthBenefitsSummary.pdf
Ohio’s Autism Insurance Directive provides autism services in the Essential Health Benefits package for plans in Ohio provided under the Affordable Care Act and to state employees as part of their employee health insurance benefits. The coverage includes 20 visits per year of speech and language therapy. Visitation is limited to a maximum weekly amount of 20 hours for individuals 21 years of age or younger.
Practitioner must be a Certified Ohio Behavioral Therapist (COBT), which can be met by Board-Certified Behavior Analyst (BCBA) requirements.
Oklahoma—Oklahoma House Bill 2962
http://webserver1.lsb.state.ok.us/cf_pdf/2015-16%20ENR/hB/HB2962%20ENR.PDF
The state of Oklahoma Requires all a health benefit plan and the Oklahoma Employees Health Insurance Plan to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder in individuals less than nine (9) years of age, or if an individual is not diagnosed or treated until after three (3) years of age, coverage shall be provided for at least six (6) years, provided that the individual continually and consistently shows sufficient progress and improvement as determined by the health care provider.
Treatment covers “therapeutic care” provided by licensed or certified speech therapists, occupational therapists or physical therapists. Coverage is limited to $25,000 per year and 25 hours per week.
Practitioner must be a board-certified behavior analyst and licensed by the Oklahoma Licensed Behavior Analyst Board (OLBAB)
Oregon—2013 Oregon Laws, SB 365
https://www.oregonlegislature.gov/bills_laws/lawsstatutes/2011ors743A.html
The state of Oregon mandates that all health benefit plans offer cover for a child enrolled in the plan who is under 18 years of age and who has been diagnosed with a pervasive developmental disorder (including autism) all medical services, including rehabilitation services, that are medically necessary and are otherwise covered under the plan. Rehabilitation services are defined as physical therapy, occupational therapy or speech therapy services to restore or improve function.
Practitioner must be a board-certified behavior analyst or other licensed health care professional and licensed by Oregon’s Behavior Analysis Regulatory Board
Pennsylvania—Pennsylvania Laws, Act 2008-62, HB 1150 of 2008, Mandated Benefits Review
http://www.legis.state.pa.us/WU01/LI/LI/US/HTM/2008/0/0062..HTM
Pennsylvania mandates that a health insurance policy or government program to provide coverage for individuals less than 21 years of age for the diagnostic assessment and treatment of autism spectrum disorder.
Treatment includes: pharmacy care, psychiatric care, psychological care, rehabilitative care and therapeutic care (includes services provided by speech-language pathologists, occupational therapists, or physical therapists) that is medically necessary and prescribed, ordered or provided by a licensed physician, licensed physician assistant, licensed psychologist, licensed clinical social worker or certified registered nurse practitioner.
Coverage provided under this section by an insurer shall be subject to a maximum benefit of $37,080 per year and is not subject to any limits on the number of visits to an autism service provider for the treatment of autism spectrum disorders.
Practitioner must be licensed or certified through the Pennsylvania State Board of Medicine
Rhode Island—2011 Rhode Island Public Laws, Chapter 175
http://www.rilin.state.ri.us/Statutes/TITLE27/27-20.11/INDEX.HTM
The state of Rhode Island mandates that every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier to provide coverage for autism spectrum disorders.
These provisions are not subject to the Small Employer Health Insurance Availability Act, or the Individual Health Insurance Coverage Act. Benefits include coverage for applied behavior analysis, physical therapy, speech therapy, and occupational therapy services for the treatment of Autism spectrum disorder. The benefits will continue until the covered individual reaches the age of fifteen.
Coverage is limited to $32,000 annually, with no visitation limits.
Practitioner must be licensed or certified by Rhode Island’s Applied Behavior Analyst Licensing Board
South Carolina—2007 South Carolina Code 38-71-280
http://www.scstatehouse.gov/code/t38c071.php
The state of South Carolina requires a health insurance plan to provide coverage for the treatment of autism spectrum disorder. To be eligible for benefits and coverage, an individual must be diagnosed with autistic spectrum disorder at age eight or younger. The benefits and coverage provided must be provided to any eligible person under sixteen years of age.
Unfortunately, speech language services are not specifically defined in the statute. Coverage is “limited to treatment that is prescribed by the insured’s treating medical doctor in accordance with a treatment plan.” Although behavioral therapy is not specifically defined, the statute does set out a cap of $50,000 per year for coverage of behavioral therapy.
Coverage only applies to individuals who were diagnosed with ASD at 8 or younger and are 16 or younger.
South Dakota—South Dakota 2015 Laws, SB 190
http://legis.sd.gov/docs/legsession/2015/Bills/SB190ENR.pdf
Requires all individual and group health insurance policies, contracts and certificates issued by health carriers and self-funded nonfederal governmental plans with the exception of the state employee health plan sponsored by the State of South Dakota to provide coverage for treatment of autism spectrum disorder.
Treatment means evidence-based care which is prescribed or ordered for a person diagnosed with an autism spectrum disorder by a licensed physician or psychologist, including: behavioral health treatment; pharmacy care; and therapeutic care. Therapeutic care is not further defined.
Coverage is limited to $36,000 for children through the age of six, $25,000 from ages 7-13, and $12,500 for ages 14-18. With no visitation limits
Practitioner must be licensed by the South Dakota Social Work Licensing Board
Tennessee—2006 Tennessee Public Acts, Chapter 894, Tennessee Code Ann. 56-7-2367
https://www.tn.gov/content/dam/tn/didd/documents/divisions/policy-and-innovation/autism-council/CI%20Overview.pdf
The state of Tennessee requires that all health insurance policies that provide benefits for neurological disorders. Coverage is limited to deductible requirements for other neurological disorders, with no visitation limits. Coverage applies to individuals 12 years of age and younger.
Practitioner must be a board-certified behavior analyst and licensed by the Applied Behavior Analyst Licensing Committee
Texas—Texas Insurance Code 1355.015
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1355.htm#1355.015
The state of Texas requires a health benefit plan to provide coverage to an enrollee who is diagnosed with autism spectrum disorder from the date of diagnosis until the enrollee completes nine years of age. If an enrollee who is being treated for autism spectrum disorder becomes 10 years of age or older and continues to need treatment, this does not preclude coverage of treatment and services.
Treatment may include services such as: evaluation and assessment services; applied behavior analysis; behavior training and behavior management; speech therapy; occupational therapy; physical therapy; or medications or nutritional supplements used to address symptoms of autism spectrum disorder.
Coverage is limited to annual deductibles, copayments, and coinsurance required for other treatments under the health benefit plan. Though there are no visitation limits.
Practitioner must be a licensed or certified health care practitioner or acting under the supervision of a licensed or certified practitioner (legislation expected to pass in 2017 will clarify that practitioner be a board-certified behavior analyst)
Utah—2014 Utah Law, SB 57
http://le.utah.gov/~2014/bills/static/sb0057.html
Utah requires a health benefit plan offered or renewed in the individual market or large group market to provide coverage for the treatment of autism spectrum disorder for children 2 to 9 years of age. Treatment includes:
Behavioral health treatment
Pharmacy care
Psychiatric care
Psychological care
Therapeutic care is provided by licensed or certified speech therapists, occupational therapists, or physical therapists.
Visitation is limited to 600 hours per year or 11.5 hours per week.
Practitioner must be a board-certified behavior analyst or other licensed health professional whose scope of practice includes mental health services, licensed by the state’s Department of Occupations and Licensing
Vermont—2012 Vermont Acts, Act 158
http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=08&Chapter=107&Section=04088i
The state of Vermont requires a health insurance plan to provide coverage for the diagnosis and treatment of autism spectrum disorders, including applied behavior analysis supervised by a nationally board-certified behavior analyst, for children under the age of 21, beginning at 18 months of age and continuing until the child reaches age six or enters the first grade, whichever occurs first.
Treatment includes:
Habilitative or rehabilitative care
Pharmacy care
Psychiatric care
Psychological care
Therapeutic care provided by licensed or certified speech-language pathologists, occupational therapists, physical therapists, or social workers), if the physician or psychologist determines the care to be medically necessary.
Coverage is required to not exceed benefits offered under the Patient Protection and Affordable Care Act. With no visitation limits.
Practitioner must be a board-certified behavior analyst or licensed by Vermont’s Office of Professional Regulation
Virginia—2015 Virginia Acts, Chapter 650
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+38.2-3418.17
The state of Virginia requires all health insurance plans to provide coverage for the diagnosis and treatment of autism spectrum disorder in individuals from age two through age six. An individual who is being treated and continues to need treatment for autism spectrum disorder and becomes seven years of age or older is not precluded from coverage of treatment and services.
Treatment shall be determined by a licensed physician or a licensed psychologist to be medically necessary and includes: Behavioral health treatment
Pharmacy care
Psychiatric care
Psychological care
Therapeutic care provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers
Applied behavior analysis when provided or supervised by a board-certified behavior analyst who shall be licensed by the Board of Medicine. Certain insurers may be exempt from requirements for 1 year and may reapply for the exemption yearly.
Coverage is limited to $35,000 annually unless specified a higher amount by the insurer. Coverage Applies to individuals from ages 2-10
Practitioner must be a board-certified behavior analyst and licensed by the Virginia Board of Medicine
Washington—Senate Bill 5059
https://www.autismspeaks.org/sites/default/files/docs/ASLRC/wa.stateorder_10.20.2014.pdf
The state of Washington directs that all state-regulated private health plans provide coverage for medically necessary treatment of autism, including coverage of speech, occupational, physical, and ABA therapy. The order also covers new health plans sold through the state healthcare marketplace created under the Affordable Care Act. Without coverage or visitation limits or age restrictions.
West Virginia—2011 West Virginia Act, Chapter 13
http://www.legis.state.wv.us/Bill_Status/bills_text.cfm?billdoc=HB2693%20SUB%20ENR.htm&yr=2011&sesstype=RS&i=2693
The state of West Virginia requires health insurance plans to include coverage for diagnosis, evaluation, and treatment of autism spectrum disorder in individuals aged eighteen months to eighteen years. The individual must be diagnosed with autism spectrum disorder at age 8 or younger.
Treatment shall be determined to be medically necessary by a licensed physician or licensed psychologist.
However, speech language services are not clearly defined in the statue. However, applied behavioral analysis is specifically included and coverage limitations are set out.
Coverage is limited to $30,000 per year for the first three years of treatment and $2,000 per month after three years. Though there are no visitation limits
Practitioner must be a board-certified behavior analyst or certified by a similar national organization.
Wisconsin—Wisconsin Statues 632.895 and 609.87, 2009 Wisconsin Laws, Act 28
https://docs.legis.wisconsin.gov/statutes/statutes/632/VI/895/12m
The state of Wisconsin requires every disability insurance policy, and every self−insured health plan of the state or a county, city, town, village, or school district, to provide coverage for an insured of treatment for the mental health condition of autism spectrum disorder if the treatment is prescribed by a physician and provided by any of the following who are qualified to provide intensive−level services or non-intensive−level services: a psychiatrist; a psychologist; a social worker; a paraprofessional working under the supervision of a psychiatrist, psychologist or social worker; a professional working under the supervision of an outpatient mental health clinic; a speech−language pathologist; or an occupational therapist.
The coverage required shall provide at least $50,000 for intensive−level services per insured per year, with a minimum of 30 to 35 hours of care per week for a minimum duration of 4 years, and at least $25,000 for non-intensive−level services per insured per year.
Practitioner must be a board-certified behavior analyst and licensed by the Wisconsin Department of Safety and Professional Services
Wyoming—Wyoming Department of Health State Medicaid Policy
https://health.wyo.gov/healthcarefin/medicaid/
Wyoming manages ABA therapy services through the state’s Medicaid programs. There are no coverage limits. Though visitation is limited to 20 visits annually unless otherwise specified by a medical professional. Coverage requirement only applies to individuals age 20 and younger
Practitioner must be a board-certified behavior analyst, a board-certified assistant behavior analyst, or a registered behavior technician under the supervision of a BCBA
