Mandating coverage for

by  |  06-May-2019 23:24

Therapeutic care means a service provided by a licensed speech-language pathologist, occupational therapist, or physical therapist.

§417-E:2 Requires specified health insurance policies and health benefit plans to provide benefits for treatment of autism or other developmental disability. 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. Certain insurers may be exempt from requirements for 1 year and may reapply for the exemption yearly. The order also covers new health plan sold through the state healthcare marketplace created under the Affordable Care Act.

§-6ii; Requires 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, for: Coverage shall be limited to $36,000 annually and shall not exceed $200,000 in total lifetime benefits. Note: Speech language services are not specifically defined in the statute. 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. 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. Therapeutic care means services provided by licensed or certified speech therapists, occupational therapists, or physical therapists. The provisions go into effect on or after July 1, 2011, on such date as a health insurer offers, issues, or renews the health insurance plan, but in no event later than July 1, 2012. Treatment shall be determined by a licensed physician or a licensed psychologist to be medically necessary, and includes: (i) behavioral health treatment, (ii) pharmacy care, (iii) psychiatric care, (iv) psychological care, (v) therapeutic care (which includes services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers), and (vi) applied behavior analysis when provided or supervised by a board certified behavior analyst who shall be licensed by the Board of Medicine. § 38.2-3418.17 As the result of litigation, Washington state Insurance Commissioner, Mike Kreidler, directed all state-regulated private health plans to provide coverage for medically necessary treatment of autism, including coverage of speech, occupational, physical and ABA therapy.

§31-3171.01 [PDF] (as amended by Act 20-336 [2013]) Requires health insurance plans to provide coverage to an eligible individual for: Coverage for the services shall be limited to $36,000 annually and may not exceed $200,000 in total lifetime benefits for an individual under 18 years of age or an individual 18 years of age or older who is in high school who has been diagnosed as having a developmental disability at 8 years of age or younger. Coverage is "limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan." Citation: Ind. §27-8-14.2; §27-13-7-14.7 Requires a group plan 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. Effective January 1, 2011, requires insurance coverage for autism.

Coverage includes therapy services provided by a licensed or certified speech therapist or speech-language pathologist. Coverage includes behavioral health treatment, pharmacy care, psychiatric care, psychological care and therapeutic care, including therapy services provided by a licensed speech pathologists. 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. Note: Speech language services are not specifically defined in the statute.

946 [2011]) Requires all health benefit plans issued or renewed after July 1, 2010 to provide coverage for the assessment, diagnosis, and treatment of autism spectrum disorders for a child. 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; and 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. Note: Speech language services are not clearly defined in the statue.

Community Discussion