Law to Expand Required Autism Coverage
Insurers will be required to pay for a broad range of services for children with autism under a new state law passed this summer. The ARICA Bill (An Act Relative to Insurance Coverage for Autism) , which goes into effect Jan. 1, 2011 mandates coverage for early and intensive interventions, including “applied behavioral analysis,’’ which trains children with autism and related disorders in social, verbal, and motor skills. Individuals with autism will have coverage for medically necessary treatment with no age caps or dollar limits.
ARICA Provisions
- ARICA requires private health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary
- ARICA includes coverage of the following treatments: Habilitative or rehabilitative care, Pharmacy care, Psychiatric care, Psychological care, Therapeutic care, Applied Behavior Analysis (ABA)
- There are no dollar or age caps on benefits
- The law contains a three year opt out provision for health insurance plans if they can prove that providing coverage of ABA has increased their premiums by more than 1%
- The law does not affect educational services provided under IFSP, IEP, or ISP
- The law applies only to fully-funded health plans governed by state law and to state health plans offered to public employees (i.e., not to self-funded plans)
Proponents of the bill claim potential savings would be realized not only by families affected by autism, but also by the Commonwealth. They estimate the new law will
- save approximately $7 million in reduced Early Intervention costs to DPH. (Note: despite the recent changes to EI legislation increasing insurance reimbursement limits for EI, specialty services are not covered and continue to remain obligations of the State).
-Adapted from: “Summary of the Autism Insurance Reform Bill in Massachusetts” http://www.autismvotes.org/site/c.frKNI3PCImE/b.4432481/k.90A7/Massachusetts.htm retrieved 9/22/10 and New England In Brief, “ Law to expand required autism coverage”, August 4, 2010, http://www.boston.com/news/local/massachusetts/articles/2010/08/04/law_to_expand_required_autism_coverage/, retrieved 8/4/10. Thanks to Andra Sobran, for bringing this new law to our attention.
- and reduce Special Education costs. (Studies indicate that 20-50% of the students with ASD who receive appropriate intervention are able to participate in regular education classes, indistinguishable from their peers. 90% show improvement, which also reduces the level of special education support needed.)
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