Autism Legislation: What It Means for Your Child
The Autism News | English
Imagine this: an issue so big that when the governor signs a much-anticipated bill into law so many parents and families want to view the historic event that the signing has to take place at Fenway Park in Boston, instead of the State House, to accommodate the crowd.
Well, that’s exactly what happened on August 3, 2010 when Gov. Deval Patrick signed House Bill 4935 (an Act Relative to Insurance Coverage for Autism Spectrum Disorder, or ARICA) into law. As the crowd cheered, Massachusetts, finally having recognized the unfair and unreasonable burden imposed on families with children diagnosed with autism, became the 23rd state to pass such legislation.
Effective Jan. 1, 2011, private health-insurance plans, employees and retirees under the state plan, hospital service plans, and HMOs are now required to provide coverage of evidence-based, medically necessary autism therapies for diagnosed persons of all ages. After being deemed medically necessary by a doctor, coverage will include habilitative and rehabilitative treatments, psychiatric and other therapeutic care, diagnostic tests, applied behavioral analysis and health treatments, pharmaceuticals, and other care provided, prescribed, or ordered by a licensed physician or psychologist for a person on the autism spectrum, including speech, occupational therapy, and physical therapy. There is no age restriction for any of these treatments to begin or end.
Additionally, insurers cannot establish dollar-amount, annual, or lifetime service limitations on the required coverage that are less than that for other physical conditions, and they are prohibited from limiting the number of visits an individual makes to an autism-service provider. Implementation of ARICA is, however, based on each policy’s specific annual renewal date, so coverage goes into effect only when your company’s insurance plan renews after Jan. 1, 2011.
There are several types of plans, however, that are not subject to ARICA. These include self-funded plans, which are regulated by ERISA and therefore subject to federal laws, unless they comply with state laws as a matter of practice. Importantly, services received under MassHealth and CommonHealth are also not subject to ARICA.
Contacting your employer is the easiest way to determine if they are subject to this new law, and for those covered by MassHealth and CommonHealth, families with autistic children under the age of 9 can apply for the Mass. Children’s Autism Medicaid Waiver through the Department of Developmental Services. Additionally, if your plan is regulated by ERISA, the recently enacted federal health care reform contains language that will eventually cover autism treatment. Other caveats to the new law include a clause wherein insurers can opt out of providing coverage for three years if their costs rise by more than1% per year. However, this determination is to be made based on an independent review and not by the insurers themselves.
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