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Autism Insurance Mandate by State

By June 21, 2021January 14th, 2022No Comments

What is an Autism mandate?

All 50 U.S states have adopted insurance mandates for autism spectrum disorder. This mandate requires that insurance companies provide some type of coverage for individuals with an autism diagnosis. The rules and laws regarding the coverage vary by state and are updated and amended over time.

Disclaimer: Below are brief summaries on the mandates. Information was last gathered in June 2021.

 

1.    Alabama (effective Oct 1st, 2017)

Requires certain health benefit plans to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder for people aged eighteen or under. The law covers the following treatments which might be prescribed by the insured’s licensed physician or licensed psychologist:

  • Behavioral health treatment, including Applied Behavior Analysis (ABA)
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Speech Therapy, Occupational Therapy, and Physical Therapy
  • Screening, diagnosis, and treatment of Autism Spectrum Disorder

Citation: Ala. Code §10A-20-6.16 and 27-21A-23

2.    Alaska (effective January 1, 2013)

Requires specific insurers to offer coverage for the diagnosis and treatment of Autism Spectrum Disorder for individuals under 21. Individuals are allowed to have unlimited visits to an autism service provider. This law covers the following treatments:

  • Diagnosis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Applied Behavior Analysis and other structured behavioral therapies
  • Speech Therapy, Occupational Therapy, and Physical Therapy

Citation: Alaska Stat. §21.42.397

3.   Arizona (effective June 30th, 2009)

Coverage for medically essential behavioral therapy treatments may not be excluded or denied. This coverage is subject to a $50,000 maximum benefit per year for any eligible individuals up to the age of nine and a $25,000 maximum benefit for any eligible individuals ages nine to sixteen. Requires specific health insurers to offer coverage for the diagnosis and treatment of autism spectrum disorder for individuals. This law covers the following treatments:

  • Diagnosis
  • Behavioral Therapy Services

Citation: HB 2847

4.    Arkansas (effective October 1st, 2011)

Requires health insurance plans issued on or after October 1, 2011, to provide for coverage for the diagnosis and treatment of Autism Spectrum Disorder. This law covers the following treatments:

  • Diagnosis
  • Applied Behavior Analysis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care (Speech Therapy, Occupational Therapy, and Physical Therapy)
  • Equipment determined necessary to provide evidence-based treatment
  • Any medically necessary and evidence-based care (as determined by a licensed physician)

Citation: Ark. Code Ann. §23-99-418

5.     California (Effective July 12th, 2011)

Requires certain insurers to provide coverage for Autism Spectrum Disorder. Treatment has to be prescribed by a licensed physician and provided by a qualified autism service provider, certified autism service professional, or certified autism service paraprofessional:

  • Applied Behavior Analysis
  • Evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with a pervasive developmental disorder or autism and includes speech-language pathology and audiology

Citation: Cal. Health & Safety Code §1374.73

6.    Colorado (effective January 1st, 2017)

Requires all health insurance plans issued or renewed after July 1, 2010 to offer insurance for the evaluation, diagnosis, and treatment of Autism Spectrum Disorders for a child. Treatment for autism spectrum disorders is described to consist of services that can be medically necessary, appropriate, effective, or efficient. This law covers the following treatments:

  • Diagnosis
  • Behavior Training, Behavior Management, and Applied Behavior Analysis
  • Habilitative or rehabilitative care (e.g. Speech Therapy, Occupational Therapy, and Physical Therapy)
  • Pharmacy care
  • Psychiatric care
  • Psychological care, including family counseling

Citation: SB 15-015

7.    Connecticut (effective January 1st, 2010)

Requires every group health benefits policy to offer insurance for the diagnosis and treatment of Autism Spectrum Disorders. These services have to be medically necessary, recognized and ordered by a licensed physician, psychologist, or clinical social worker in agreement with a treatment plan. This law covers the following treatments:

  • Diagnosis
  • Behavioral therapy, including Applied Behavior Analysis
  • Prescription Drugs
  • Psychiatric care and psychological care
  • Speech Therapy, Occupational Therapy, and Physical Therapy

Citation: Conn. Gen. Stat. §38a-514b (as amended by S.B. 301 (2009)

8.    Delaware (effective December 11th, 2012)

Requires that all individual health plans shall provide insurance for the screening, diagnosis, and treatment of Autism Spectrum Disorders for anyone under 21 years old. The annual coverage limits for Applied Behavior Analysis provide that coverage should not be subject to dollar limits that are less favorable than dollar limits for physical illness. An insurer may have the right to request an evaluation of the treatment. This law covers the following treatments:

  • Behavioral health treatment (including Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care and Psychological Care
  • Therapeutic care (Speech Therapy, Occupational Therapy, and Physical Therapy)
  • Necessary Equipment

Citation: Del. Code Ann. tit. 18, §3361

9.    District of Columbia (effective January 1, 2014)

Requires the essential health advantages benchmark plan to include habilitative services, along with applied behavioral evaluation for the treatment of Autism Spectrum Disorder.

Citation: D.C. Code Ann. §31-3171.01

10.    Florida (effective on April 1, 2009)

Requires medical insurance plans to offer coverage to an eligible individual for:

  • Well-infant and well-child screening for diagnosing the presence of autism spectrum disorder
  • Treatment of Autism Spectrum Disorder via Speech Therapy, Occupational Therapy, bodily therapy, and implemented conduct analysis

Coverage for the treatments will be limited to $36,000 yearly and cannot exceed $200,000 in total lifetime benefits for an individual less than eighteen years old or an individual that is 18 years and older who is in high school who has been diagnosed as having a developmental disability at eight years of age or younger.

Citation: Fla. Stat. Ann. §627.6686

11.    Georgia (effective in 2015)

Requires accident and sickness contracts, regulations or benefit plans to offer medically essential coverage for Autism Spectrum Disorder for children under six years old. Coverage consists of therapy offerings provided by an authorized or licensed speech therapist or speech-language pathologist. The coverage limit of applied behavior analysis to individuals twenty years old and older up to $35,000 per year. This law covers the following treatments:

  • Diagnosis and treatment of Autism Spectrum Disorder
  • Habilitative or rehabilitative services including Applied Behavior Analysis
  • Counseling services provided by a licensed psychiatrist, licensed psychologist, professional counselor, or clinical social worker
  • Speech, Occupational and Physical Therapy

Citation: Ga. Code Ann. 33-24-59.10

12.     Hawaii (effective January 1st, 2016)

Requires individual/organization health or sickness coverage regulations issued January 1, 2016 to offer insurance for individuals younger than fourteen for the diagnosis and treatment of autism. This law covers the following treatments:

  • Applied Behavior Analysis
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Speech, Occupational and Physical Therapy

Citation: Haw. Rev. Stat. §431:10A

13.    Indiana (effective on December 12, 2008.)

Requires specific health insurers to provide people under 21 years old insurance for the diagnosis of autism spectrum disorders and for the treatment of Autism Spectrum Disorders. Treatment consists of the following care prescribed, provided, or ordered for a person recognized with an Autism Spectrum Disorder:

  1. A) A licensed physician to exercise medicine in all its branches or
  2. B) A certified, registered, or certified healthcare professional with experience in treating effects of autism spectrum disorders while the care is decided to be medically vital and ordered by a medical doctor certified in all its branches; psychiatric care, (direct, consultative, or diagnostic treatments offered by a licensed psychiatrist; psychiatric care, direct or consultative services provided licensed psychologist; habilitative or rehabilitative care, counseling, and guidance services and treatment programs, such as behavior analysis, that intend to develop, maintain, and restore the functioning of a person; therapeutic care, such as Behavioral, Speech, Occupational, and Physical Therapies.

Coverage provided should be a maximum benefit of $36,000 a year, however, it should not limit the number of visits to a service provider.

Citation: Ill. Comp. Stat. ch. 215, § 5/356z.14

14.    Idaho (effective on July 1, 2001)

Requires group and individual insurance plans to offer insurance for the treatment of a pervasive developmental disorder of an insured. The insurance required may not be subjected to dollar limits, deductibles, or coinsurance provisions which can be much less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that practice to the physical illness commonly under the accident and illness insurance policy.

Citation: IC-27-8-14.2

15.     Iowa (effective January 1, 2018)

Requires state employee healthcare plans to offer insurance for the diagnosis and treatment of Autism Spectrum Disorders for anyone younger than 21 years old. Treatment is described as pharmacy care, psychiatric care, mental care, rehabilitative care, and therapeutic care. This mandate establishes a $36,000 yearly maximum benefit on insurance for kids with an autism spectrum disorder. The insurance plan allows for unlimited visits to an autism service provider.

Citation: Iowa Code §514C.28

16.    Kansas (effective January 1st, 2014)

Benefit coverage for all insured persons diagnosed with one or more Autism Spectrum Disorders who are between 7 years or older and 19 years old, should not exceed the US $ 27,000 per year. Requires a large group health insurance policy, medical treatment plan, contract, hospital service contract, hospital and medical treatment contract, fraternal welfare or health care organization that provides accident insurance and health services and that is delivered, issued for delivery, modified or renewal, in order to provide coverage for the diagnosis and treatment of Autism Spectrum Disorders to all insured persons under the age of 12.

Citation: HB 2744

17.   Kentucky (effective January 1, 2011)

Requires that large group health insurance plans, as well as individual and small group health insurance plans, cover the diagnosis and treatment of Autism Spectrum Disorders. This law covers the following treatments:

  • Diagnosis
  • Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
  • Medical Care
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (e.g. Speech, Occupational, and Physical Therapy)

Citation: HB 159

18.    Louisiana (effective on January 1, 2014)

Requires any health insurance plan that covers the diagnosis and treatment of autism spectrum disorders in people under 21 years old. The coverage is subject to a maximum benefit of $ 36,000 per year and a maximum lifetime benefit of $144,000.  Individuals are allowed unlimited visits to an autism service provider care prescribed, provided, or ordered by a doctor or psychologist appointed to a person diagnosed with any of the autism spectrum disorders in the state of Idaho and must be approved and the provision of such care. This law covers the following treatments:

  • Diagnosis
  • Habilitative or rehabilitative care (Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (Speech, Occupational and Physical Therapy)

Citation: La. Rev. Stat. Ann. §22-1050

19.    Maine (amended January 12, 2014)

Requires all individual health insurance policies, contracts, group health insurance policies, to cover the diagnosis. The policy or contract may limit behavioral analysis coverage to $36,000 per year, and the policy or contract includes unlimited visits. The law also requires the Department of Professional and Financial Regulation, Office of Insurance, to review and evaluate the financial and social impact and medical effectiveness of this mandatory health insurance benefit and submit a report to lawmakers by February 1, 2015. The following treatments are covered by this law:

  • Diagnosis
  • Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
  • Counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor, or clinical social worker
  • Speech, Occupational, and Physical Therapy

Citation: LD 2768

20.    Maryland (effective November 1st, 2013)

Requires insurers, nonprofit health insurers, and health organizations to cover habilitative treatments to children less than 19 years old with a congenital or genetic birth defect (including autism). This law covers the following services:

  • Behavioral health treatment, including Applied Behavior Analysis (ABA). ABA may not be denied on the assertion that it is “experimental” or “investigational.”
  • Psychological care, including direct or consultative services and psychotherapy
  • Speech, Occupational and Physical Therapy

Citation: MD Statute §694

21.    Massachusetts (effective on January 1, 2011)

The insurance coverage for autism includes the following treatment prescribed, provided, or ordered to a person diagnosed with Autism Spectrum Disorder by a licensed physician or licensed psychologist who determines a medical need. Specific insurers can be exempt from the requirements for three years. This law covers the following treatments:

  • Diagnosis
  • Habilitative or Rehabilitative Care (e.g. Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Speech, Occupational and Physical Therapy

Citation: H4935

22.     Michigan (effective on October 15, 2012)

Requires group or non-group certification from a healthcare company to cover Autism Spectrum Disorder Diagnosis and Autism Spectrum Disorder Treatment or licensed psychologist. Coverage for the treatment of Autism Spectrum Disorders may be limited to one member up to the age of 18 and subject to a maximum annual benefit as follows: (i) For an insured member up to the age of 6, $ 50,000.00; (ii) For insured member ages 7 to 12, $ 40,000.00; and (iii) For an insured member aged 13 to 18, $ 30,000.00. This law covers the following treatments:

  • Behavioral Health Treatment (e.g. Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care and Psychological care
  • Speech, Occupational and Physical Therapy

Citation: SB 414, SB 415, and SB 981

23.     Minnesota (effective January 1, 2014)

For all major employer’s health insurance plans, the government employee group insurance program must cover the diagnosis, assessment, multidisciplinary assessment, and medically necessary care of children less than 18 years old with Autism Spectrum Disorders. The assistant receives early intensive intervention to diagnose an autism spectrum disorder. This law covers the following treatments:

  • Diagnosis, evaluation, and multidisciplinary assessment
  • Early intensive intervention (e.g., autism treatment options based in behavioral and developmental science, which may include modalities such as applied behavior analysis, developmental treatment approaches, and naturalistic and parent training models.)
  • Neurodevelopmental and behavioral health treatment
  • Occupational therapy
  • Physical therapy
  • Medications

Citation: HF 1233

24.     Missouri (effective, January 1, 2011, expanded in 2019)

Requires that all group health plans delivered, issued for delivery, amended, or renewed starting January 1, 2011, provide coverage for the diagnosis and treatment of Autism Spectrum Disorders, provided that such diagnosis and treatment is not already covered by the Health Care Plan. Requires that treatment for a person who has been diagnosed with autism spectrum disorder must be by a licensed doctor or psychologist. This law covers the following treatments:

  • Diagnosis
  • Habilitative or Rehabilitative Care (e.g. Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (e.g. Speech, Occupational and Physical Therapy)

Citation: Mo. Rev. Stat. §376.1224

25.     Mississippi (effective, January 1, 2016)

Requires health insurance to cover the screening, diagnosis, and treatment of Autism Spectrum Disorders. Treatment means evidence-based care given, prescribed, or directed to a person diagnosed with Autism Spectrum Disorder by a licensed physician or psychologist who determines the treatment to be medically necessary. This law covers the following treatments:

  • Screening and diagnosis
  • Applied Behavior Analysis
  • Pharmacy care, psychiatric care, psychological care
  • Speech, Occupational and Physical Therapy

Citation: Miss. Code Ann. §83-9

26.    Montana (effective January 1st, 2010)

Requires that each group disability policy, certificate of insurance, or membership contract issued, modified, renewed, or amended in this state to cover the diagnosis and treatment of Autism Spectrum Disorder for an insured child of 18 years old or younger. The coverage for the treatment of Autism Spectrum Disorders in this section can reach a maximum benefit of:

  • $50,000 a year for a child 8 years old or younger
  • $20,000 a year for a child 9 years old through 18 years old

This law covers the following treatments:

  • Diagnosis
  • Habilitative or rehabilitative (e.g. Applied Behavior Analysis)
  • Medications
  • Psychiatric or psychological care
  • Therapeutic care (Speech, Occupational and Physical Therapy)

Citation SB 234

27.     Nebraska (effective, January 1, 2015)

Requires coverage for any individual or group insurance policy to provide coverage for the detection, diagnosis, and treatment of Autism Spectrum Disorders. This law covers the following treatments:

  • Diagnosis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Behavioral health treatments, including Applied Behavior Analysis (ABA)
  • Therapeutic Care (Speech, Occupational and Physical Therapy)

Citation: Neb. Rev. Stat. §44-7,106

28.    Nevada (effective on January 1, 2011)

Requires individual health insurance plan to provide an insurance option for the screening and diagnosis of Autism Spectrum Disorders and for the treatment of Autism Spectrum Disorders for insured persons eighteen years old and younger or if the person is enrolled in high school until they reach the of the age of twenty-two. The treatment of autism spectrum disorders should be specified in a treatment plan. This law covers the following treatments:

  • Screening and diagnosis
  • Habilitative or rehabilitative (including Applied Behavior Analysis)
  • Prescription Care
  • Psychiatric and Psychological Care
  • Speech, Occupational and Physical Therapy

Citation: AB 162

29.    New Hampshire (effective, January 1, 2011)

Requires coverage for the diagnosis and treatment of pervasive developmental disorder or autism for all policies, contracts, and group certificates issued or renewed after January 1, 2011. This law covers the following treatments:

  • Applied Behavior Analysis
  • 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
  • Speech, Occupational and Physical Therapy

Citation:  HB 569

30.    New Jersey (effective, February 8, 2010)

This law should cover the costs of identifying and diagnosing autism or other developmental disorders. Additionally covers the cost of medically necessary physical therapy, occupational therapy, and speech therapy prescribed through a treatment plan for autism or other developmental disorders. Also, behavioral interventions based on Applied Behavior Analysis (ABA) and related structured behavioral programs for diagnosing autism ABA therapy achievements are limited to autistic children under the age of twenty-one according to the New Jersey Early Intervention System (NJEIS).

Citation: N.J. Rev. Stat.

31.    New Mexico (effective January 1, 2010, adjusted June 15th, 2019)

Requires specified health insurance policy, healthcare plan, or certificate of health insurance to provide coverage to any 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:

  1. well-baby and well-child screening for diagnosing the presence of autism spectrum disorder; and
  2. treatment of Autism Spectrum Disorder through Speech Therapy, Occupational Therapy, Physical Therapy, and Applied Behavioral Analysis.

 This law covers the following treatments:

  • Screening and diagnosis
  • Applied Behavior Analysis
  • Speech, Occupational and Physical Therapy

Citation: N.M. Stat. Ann

32.    New York (effective on November 1, 2012)

Requires all policies that provide physician services, senior physician, or similar comprehensive coverage to provide coverage, for the diagnosis, and treatment of Autism Spectrum Disorders. This law covers the following treatments:

  • Diagnosis
  • Behavioral health treatment (Applied Behavior Analysis)
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (i.e. services provided by licensed or certified speech therapists, occupational therapists, social workers, and physical therapists)

Citation: N.Y. Isc Law §3216

33.    North Carolina (amended May 2021)

Requires health insurance plans to cover the detection, diagnosis, and treatment of Autism Spectrum Disorders. This law covers the following treatments:

  • Adaptive Behavior Treatment
  • Psychiatric Care
  • Psychological Care
  • Speech, Occupational and Physical Therapy
  • Pharmacy Care

Citation: SB 103

34.    North Dakota (effective July 10, 2018)

Requires an insurance company, nonprofit health care company, or organization to deliver, issue, execute, or renew a group health insurance policy or health service contract, on a group or franchise. or an association to offer a policy or contract, benefits of the same type offered under the policy or contract for other illnesses, for health care services for any person covered by the policy or contract, for diagnosis, assessment, and treatment of mental disorders of other similar diseases. This bulletin covers the following treatments:

  • Behavioral health treatment, including Applied Behavior Analysis
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care (Speech, Occupation, and Physical Therapy)

Citation: N.D. Cent. Code §26.1-36-09

35.    Ohio (effective in 2017)

“Requires insurance coverage for the screening, diagnostic testing, and treatment of autism spectrum disorder.” This law covers the following treatments:

  • Speech therapy
  • Occupational Therapy
  • Clinical Therapeutic Intervention, including Applied Behavior Analysis
  • Mental/behavioral health outpatient services

Citation: HB 463

36.    Oklahoma (effective November 1, 2016)

Requires coverage for autistic disorders under certain circumstances, provides no coverage limitations for treatment visits, requires coverage be equal to other certain health benefit plans, specifies that certain benefits shall not be limited; directs Insurance Commissioner to annually adjust the maximum benefit, and requires that coverage for applied behavior analysis includes certain services. This law covers the following treatments:

  • Screening, Diagnosis, and Treatment of Autism Spectrum Disorder (ASD)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care
  • Behavioral Health Treatment
  • Applied Behavior Analysis

Citation: HB 29620

37.    Oregon (effective on January 1, 2016)

Requires health insurance plans that cover a child under eighteen years old diagnosed with a pervasive developmental disorder (including autism) for all medical treatments, including rehabilitation services, that are medically essential and otherwise covered under the plan. This law covers the following treatments:

  • Screening and diagnosis
  • Medically necessary treatment for autism spectrum disorder* (e.g. Applied Behavior Analysis)

Citation: SB 365

38.    Pennsylvania (effective July 1, 2009)

Requires health insurance or government program to cover individuals under twenty-one years old for the diagnostic evaluation and treatment of Autism Spectrum Disorders for a maximum benefit of $36,000 per year. This law covers the following treatments:

  • Diagnosis
  • Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (Speech Therapy, Occupational Therapy, and Physical Therapy)

Citation: HB 1150

39.    Rhode Island (January 1, 2012)

Require specific contracts and guidelines to cover Autism Spectrum Disorder. Benefits for the treatment of autism spectrum disorders apply until the insured person turns fifteen years old. Applied behavior analysis coverage is capped at $32,000 per year. This law covers the following treatments:

  • Pharmaceuticals
  • Applied Behavior Analysis
  • Physical Therapy and Speech Therapy
  • Psychology, Psychiatric, and Occupational Therapy Services

Citation: R.I. Gen. Laws §20.11

40.    South Carolina (effective July 8, 2008)

Requires health insurance to cover autism spectrum disorder treatment. To be eligible for benefits and insurance coverage, the child must be eight years old or younger when diagnosed with an autism spectrum disorder. The benefits and coverage must be provided to any eligible person under sixteen years of age.

Citation: S.C. Code Ann. §38-71-280

41.    South Dakota (effective January 1, 2015)

Requires health insurance for applied behavioral analysis in Autism Spectrum Disorder. Providers that such coverage may be subject to prior approval, pre-authorization, and management of care. Requirements, including individual visit limits, dollar limits, deductibles, co-payments, or co-insurance requirements applicable to other medical or surgical services covered by the policy. Applied Behavior Analysis coverage will also be available on the South Dakota ACA marketplace individual and small-group plans as a necessary health benefit. This law covers the following treatments,

  • Behavioral Health Treatment (ABA)
  • Pharmacy Care
  • Therapeutic Care

Citation: SB 190

42.   Tennessee (effective 2006, revised in 2019)

This law defines autism spectrum disorder as a neurological disorder. Requires that contracts and policies that provide benefits for neurological disorders provide benefits and coverage for the treatment of children under twelve years old with autism. “Any treatment that is medically necessary and appropriate and not experimental… must be covered equally as described in the MHPAEA.” This law covers the following treatments:

  • Assessment, screening, and diagnosis
  • Psychological care
  • Psychiatric care
  • Speech, Occupational and Physical Therapy
  • Applied Behavior Analysis and other therapies deemed medically necessary

Citation: Tenn. Code Ann. § 56-7-2367 (2006 Tenn. Pub. Acts, Chap. 894;

43.    Texas (effective in 2007 revised in 2013)

Requires a health insurance plan to cover an individual diagnosed with Autism Spectrum Disorder from the date of diagnosis until the member is nine years old. If the individual turns ten years old or older and still needs treatment, this does not exclude insurance cover for treatments and services. This law covers the following treatments:

  • Evaluation and assessment services
  • Applied Behavior Analysis (ABA)
  • Behavior training and behavior management
  • Speech Therapy, Occupational Therapy, and Physical Therapy
  • Medications or nutritional supplements

Citation: HB 1919

44.    Utah ( effective January 1, 2016, revised in 2019

Requires a health insurance plan, offered in an individual market or large group market, or extended to cover treatment for Autism Spectrum Disorders. This law covers the following treatments:

  • Diagnosis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Applied Behavior Analysis and other behavioral health treatments
  • Speech Therapy, Occupational Therapy, and Physical Therapy

Citation: SB 95

45.    Vermont (amended in 2012)

Requires a health insurance plan to offer coverage for the diagnosis and treatment of Autism Spectrum Disorders, including Applied Behavior Analysis under the supervision of a state-certified behavioral analyst, for children aged eighteen months old through twenty-one years old. This law covers the following treatments:

  • Diagnosis
  • Behavioral health treatment (e.g. Applied Behavior Analysis)
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care (e.g. services provided by licensed or certified speech-language pathologists, occupational therapists, physical therapists, or social workers)

Citation:S.223

46.   Virginia (expanded in March 2020)

Requires health insurance plans issued or renewed after January 1, 2012, to cover the diagnosis and treatment of individuals with Autism Spectrum Disorder. A person who is being treated for and continues to need treatment for an autism spectrum disorder and turns seven years old. or higher is not excluded from an insurance cover for treatments and services. A licensed doctor or licensed psychologist will determine whether treatment is medically necessary. This law covers the following treatments:

  • Behavioral Health Treatment
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Car (which includes services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical speech therapists, occupational therapists, physical therapists, or clinical social workers)
  • Applied Behavior Analysis when provided by a board certified behavior analyst

Citation: SB 1031

47.    Washington (effective in 2014)

All state-regulated private health insurances shall provide coverage medically for necessary autism treatment. The contract also includes new health insurance plans that will be sold through the state health marketplace created under the Affordable Care Act. This law covers the following treatments:

  • Applied Behavior Analysis
  • Behavioral Health Treatment
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care
  • Any care for individuals with autism spectrum disorders that is demonstrated, based upon best practices or evidence-based research, to be medically necessary

Citations: SB 5059

48.    West Virginia (enacted in March 2012)

Requires that health insurance plans issued or renewed after January 1, 2012 to include coverage for the diagnosis, evaluation, and treatment of Autism Spectrum Disorders in individuals eighteen months to eighteen years old. A person must be diagnosed with an autism spectrum disorder at eight years old or younger. A licensed doctor or licensed psychologist will determine if treatment is medically necessary. An annual benefit limit of $30,000 applies only to ABA. This law covers the following treatments:

  • Diagnosis
  • Applied Behavior Analysis
  • Treatments that are medically necessary and ordered or prescribed by a licensed physician or licensed psychologist and in accordance with a treatment plan

Citations: HB 4260

49.    Wisconsin (effective on November 1, 2009)

Requires all disability insurance policies and all state, county, city, town, village, or school district health insurance plans to cover an insured person for treatment for Autism Spectrum Disorder Mental Health. The coverage required must be a minimum of $50,000 for intensive benefits per insured per year, with a minimum of 30 to 35 hours of care per week for a minimum duration of 4 years, and at least $25,000 for non-intensive benefits per insured year. This law covers the following treatments:

  • Diagnosis
  • Evidence-based behavioral therapy (e.g. Applied Behavior Analysis)
  • Psychiatric and psychological care
  • Speech Therapy and Occupational Therapy

Citation: Wis. Stat. §632.895(12m)

50.    Wyoming (effective, April 19, 2019)

This bulletin requires that all plans that have mental health insurance include evidence-based treatment for autism spectrum disorders. This bulletin covers the following treatments:

  • Behavioral health treatment, including Applied Behavior Analysis
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic Care