States mandating


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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 [2011]) 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.

§627.6686 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. 33-24-59.10 [PDF] (as amended by HB 429 [2015]) Requires individual or group accident and health or sickness insurance policies issued January 1, 2016, to provide coverage for individuals under fourteen for the diagnosis and treatment of autism. Treatment includes the following 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 health care 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. The coverage required may not 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.

Coverage under this section shall not be denied on the basis that the treatment is habilitative or nonrestorative in nature. 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 ,000 per year. Coverage for autism spectrum disorders shall be subject to ,000 maximum benefit per month, per covered individual. Coverage shall be subject to a maximum benefit of ,000 per year and a lifetime maximum benefit of 4,000.

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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. §10-16-104 Requires each group health insurance policy to provide coverage for the diagnosis and treatment of autism spectrum disorders. Effective January 1, 2015, 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. There shall not be any limits on the number of visits an individual may make to an autism services provider. §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.

Requires a health benefit plan to provide coverage for the screening, diagnosis and treatment of autism spectrum disorder for individuals age nine or under in policies and contracts to employers with at least 51 employees for at least 50 percent of its working days for the preceding calendar year. 74 [2012]) Requires policies issued by certain health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorder. Treatment includes: (i) Applied behavior analysis when provided by or supervised by a Board Certified Behavior Analyst; (ii) Pharmacy care; (iii) Psychiatric care; (iv) Psychological care; (v) Therapeutic care (which includes services provided by licensed speech therapists, occupational therapists, or physical therapists); and (vi) Equipment determined necessary to provide evidence-based treatment; provided such treatments determined by a licensed physician to be medically necessary and evidence-based. Treatments include: professional services and treatment programs, including 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.

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 created by S. 283 [2012]) 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.



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