The coverage includes 20 visits per year of speech and language therapy. 36 §6060.21 [PDF] Requires health benefit plans to 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. Requires 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. These provisions are not subject to the Small Employer Health Insurance Availability Act, or the Individual Health Insurance Coverage Act. Laws §20.11 Requires a health insurance plan to provide coverage for the treatment of autism spectrum disorder.
§58-3-192, as added by SB 676 (2015) [PDF] Governor John Kasich signed the Autism Insurance Directive in December 2012,which would include 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. §743A.190 Note: 743A.190 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. 40 §764h Requires 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, on or after January 1, 2012, to provide coverage for autism spectrum disorders.
§-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 ,000 annually and shall not exceed 0,000 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.
Covered treatment includes medically necessary pharmacy care, psychiatric care, psychological care, habilitative or rehabilitative care, and therapeutic care (which includes services provided by a licensed speech-language pathologist.) There is no limit on the number of visits an individual may make to an autism services provider. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.
§20-826.04; §20-1057.11; §20-1402.03; §20-1404.03 Requires health benefit plans issues or renewed on or after October 1, 2011 to provide for coverage for the diagnosis and treatment of autism spectrum disorder. §23-99-418 [PDF] (as created by HB 1315 ) Requires 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. Treatments include: evaluation and assessment services; Behavior training and behavior management and applied behavior analysis; habilitative or rehabilitative care, including, but not limited to, occupational therapy, physical therapy, or speech therapy, or any combination of those therapies; pharmacy care and medication; psychiatric care; psychological care; and therapeutic care, including, but is not limited to, speech, occupational, and applied behavior analytic and physical therapies. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.
Coverage includes, therapeutic care, which is habilitative or nonrestorative, provided by a licensed or certified speech therapist. Coverage includes therapeutic care, which includes services provided by a licensed speech-language pathologist. Treatment covers "therapeutic care" provided by licensed or certified speech therapists, occupational therapists or physical therapists. Coverage provided under this section by an insurer shall be subject to a maximum benefit of ,080 per year and is not subject to any limits on the number of visits to an autism service provider for treatment of autism spectrum disorders. The benefits will continue until the covered individual reaches the age of fifteen. The benefits and coverage provided must be provided to any eligible person under sixteen years of age. §38-71-280 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. 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 includes: (A) behavioral health treatment; (B) pharmacy care; (C) psychiatric care; (D) psychological care; and (E) therapeutic care. Treatment includes: habilitative or rehabilitative care; pharmacy care; psychiatric care; psychological care; and therapeutic care (includes services 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. 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.
Ann §59A-22-49; §59A-23-7.9; §59A-46-50; §59A-47-45 Requires 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. Isc Law §3216 Requires health benefit plans to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. Citation: EHB Benchmark Plan for Ohio [PDF] Requires all plans issued or renewed on or after November 1, 2016, 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. Rehabilitation services is defined as physical therapy, occupational therapy or speech therapy services to restore or improve function. 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. Benefits include coverage for applied behavior analysis, physical therapy, speech therapy and occupational therapy services for the treatment of Autism spectrum disorders. To be eligible for benefits and coverage, an individual must be diagnosed with autistic spectrum disorder at age eight or younger. Codified Laws §58-17 [PDF] (as amended by SB 190 ) 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. §1355.015 Effective January 1, 2016, 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. 57 (2014)] 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, beginning at 18 months of age and continuing until the child reaches age six or enters the first grade, whichever occurs first. 8 § 4088i Requires health insurance plans issued or renewed after January 1, 2012, to provide coverage for the diagnosis and the treatment of autism spectrum disorder in individuals from age two through age six.