Mandating coverage length of time dating
Coverage for treatment of autism spectrum disorders under this section may be limited to a maximum benefit of: Citation: Mont. §33-22-515 Effective July 1, 2014, requires any individual or group sickness and accident insurance policy or subscriber contract 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 (b) any self-funded employee benefit plan to the extent not preempted by federal law, including 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. §44-7,106 Effective January 1, 2011—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. 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. Note: Speech language services are not clearly defined in the statue. Code § 5-16B-6e, 33-16-3v, 33-24-7k, 33-25A-8j (as created by HB 2693 [2011]) 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 nonintensive−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.
981 Effective January 1, 2014, 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. Children enrolled in medical assistance will receive early intensive intervention for an autism spectrum disorder diagnosis. 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. Therapeutic care must be provided by licensed speech-language pathologists. 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. §689A.0435 Requires insurance coverage for diagnosis and treatment of pervasive developmental disorder or autism for all group policies, contracts, and certificates issued or renewed on or after January 1, 2011. Treatment shall be determined to be medically necessary by a licensed physician or licensed psychologist.
Since the health law established a comprehensive set of “essential health benefits” that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University’s Center On Health Insurance Reforms.
Mandates are “not the most rational way to build a benefit package,” says Corlette.
§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 ,000 annually and may not exceed 0,000 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 ,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.
§62A-3094 Requires 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 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. §83-9 [PDF] 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. The maximum benefit amount for a covered person in any calendar year through 2012 shall be ,080. The individual must be diagnosed with autism spectrum disorder at age 8 or younger.
§376.1224 Effective, January 1, 2016, requires a health insurance policy to provide coverage for screening, diagnosis, and treatment of autism spectrum disorder. Coverage shall include: medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan. Citation: Office of the Insurance Commissioner [PDF] Requires health insurance plans issued or renewed after January 1, 2012, to include coverage for diagnosis, evaluation and treatment of autism spectrum disorder in individuals aged eighteen months to eighteen years.
Coverage is limited to treatment that is prescribed by the insured's licensed physician or licensed psychologist and includes: behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care (which includes services provided by a licensed and certified speech therapist). Code §10A-20-6.16 and 27-21A-23 [PDF] [as amended by H. 284 (2017)] Requires certain insurers to provide coverage for the diagnosis and treatment of autism spectrum disorder for individuals under 21 effective January 1, 2013. Treatment includes: diagnosis, assessment and services. Note: Speech language services are not clearly defined in the statue.
For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services.
The health law contains provisions aimed at curbing this piecemeal approach to coverage.
They may apply to all individual and group plans regulated by the state, or they may be more limited.
While patient advocates view state mandates as a crucial tool in their efforts to address coverage shortcomings, the insurance industry generally opposes mandates, saying they drive up the cost of insurance.
