Below, the green map reflects the efforts of many to pass autism insurance reform in all 50 states in the last decade. By clicking on each state, you can see all details related to a given state's insurance law as well as other relevant insurance information for each state including BCBA licensure, Medicaid, mental health parity, and more.
Click on Select a state below to view insurance details of its state-regulated autism insurance coverage.
Click here to watch a short video detailing the individuals and efforts involved in Alabama’s autism insurance reform.
AUTISM INSURANCE REFORM
Alabama’s autism insurance bill, House Bill 284, was enacted in 2017 and became effective on October 1, 2017.
WHAT SERVICES ARE COVERED BY LAW?
DOES ALABAMA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Per statute, coverage is limited to individuals under 18 years of age. Coverage for applied behavior analysis is subject to cap of $40,000 per year between ages 0 to 9 years, a $30,000 per year between ages 10 to 13 years, and $20,000 per year between ages 14 to 18 years.
However, upon implementation of HB284, BCBS-AL acknowledged that the monetary caps violated MHPAEA and would not be enforcing them (see memo in library).
Further, in response to an inquiry regarding enforcement of MHPAEA as it relates to implementation of the statutory caps by other carriers, a representative from the legal division of the Alabama Department of insurance stated the following:
“In an effort to make an educated decision on the fact situation that you gave us, the Department has reached out to our top carriers to ascertain their methods with dealing with the Autism law in Alabama as well as the Mental Health Parity and Addiction Equity Act ("MHPAEA”). The carriers informed the Department that they are aware of (MHPAEA) and its requirements. Those carriers stated that their plans do not contain age limit or dollar caps for Autism services and are complaint with MHPAEA.”[1]
The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Alabama in 2014. The Alabama licensure board can be found here.
MEDICAID
Alabama’s Medicaid program is fee-for-service. The fee schedule for ABA services under Alabama Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Alabama’s EPSDT medical necessity definition can be found in the State Administrative Code 560-x-11-.14 on page 1, paragraph 1 and in the Alabama Medicaid Provider Manual (above) on page 139.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Alabama can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
ALABAMA DEPARTMENT OF INSURANCE
The Alabama Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
[1] M.L. Wasmer (personal communication, June 25, 2021)
Click here to watch a short video detailing the individuals and efforts involved in Alaska’s autism insurance reform.
AUTISM INSURANCE REFORM
Alaska’s autism insurance bill, Senate Bill 74, was enacted in 2012 and became effective on January 1, 2013.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES ALASKA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under 21 years of age. There are no annual dollar caps on coverage.
LICENSURE
Licensure for BCBA’s was passed in Alaska in 2014 under House Bill 361. The Alaska licensure board can be found here.
MEDICAID
Alaska’s Medicaid program is fee-for-service. The fee schedule for ABA services under Alaska Medicaid can be found here.
ADULT COVERAGE
Yes. The state of Alaska offers two programs through which adults with autism can access ABA services:
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Alaska’s EPSDT medical necessity definition can be found in Alaska Admin. Code 110.210.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Alaska can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
ALASKA DEPARTMENT OF INSURANCE
The Alaska Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin B 15-05 was issued in 2015 to restate the requirements for coverage following the 2012 autism insurance reform bill.
Click here to watch a short video detailing the individuals and efforts involved in Arizona’s autism insurance reform.
AUTISM INSURANCE REFORM
Arizona’s autism insurance bill, House Bill 2847, was enacted in 2008 and became effective on June 30, 2009.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES ARIZONA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage for behavioral therapy is limited to individuals with autism that are less than 17 years of age and is subject to annual dollar caps of $50,000 per year to those under the age of 9 and $25,000 per year to those between the ages of 9 and 16. The law does not apply to the following plans:
LICENSURE
BCBA licensure was passed in Arizona in 2009 and revised in 2014 under House Bill 2173. The Arizona licensure board can be found here.
MEDICAID
Arizona’s Medicaid program – Arizona Health Care Cost Containment System (AHCCCS) - is Fee-For-Service. The fee schedule for ABA services considered by report, more information can be found here. Often, Individual health plans establish contracted rates between the MCO and ABA provider.
ADULT COVERAGE
Yes
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Arizona’s EPSDT medical necessity definition can be found in the Arizona State Administrative Code Section 9.A.A.C. 22 on page 10, column 2, paragraph 3. A medical necessary definition can also be found in Arizona’s Medical Policy Manual for EPSDT (above) in the very first paragraph.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Arizona can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
ARIZONA DEPARTMENT OF INSURANCE
The Arizona Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 2008-4 was issued in 2008 to reiterate the changes to Arizona law enacted via the autism insurance reform bill.
Click here to watch a short video detailing the individuals and efforts involved in California’s autism insurance reform.
AUTISM INSURANCE REFORM
California’s autism insurance bill, Senate Bill 946, was enacted in 2011 and became effective on July 1, 2012.
WHAT SERVICES ARE COVERED BY THE LAW?
Behavioral health treatment (e.g., Applied Behavior Analysis). For purposes of the law, “behavioral health treatment” is defined as “professional services and treatment programs, including ABA and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual.” Treatment must be prescribed by a licensed physician and provided by qualified autism serviceprovider, qualified autism service professional or qualified autism service paraprofessional.
DOES CALIFORNIA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.
LICENSURE
No.
MEDICAID
California’s Medicaid program, MediCal, is MCO. The fee schedule for ABA services under California Medicaid is not publicly available.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT Medical Necessity Definition
California’s medical necessity definition can be found in California Welfare and Institutions Code, section 14059.5, subd.
STATE MENTAL HEALTH PARITY
California has an extensive and robust history with implementing and upholding mental health parity within the state. A detailed description and background of Mental Health Parity laws and regulations for the state of California can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E. SB 855)?
Yes. In August 2020 SB 855 was passed. More information about California’s general Standards of care can be found here. The law does not apply to the following plans:
CALIFORNIA DEPARTMENT OF INSURANCE
The California Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
The state of California’s Depart of Insurance issued a notice on March 30th 2020 to allow for services to be provided via telehealth during the COVID-19 emergency.
Click here to watch a short video detailing the individuals and efforts involved in Colorado’s autism insurance reform.
AUTISM INSURANCE REFORM
Colorado’s autism insurance bill, Senate Bill 09-244, was enacted in 2009 and became effective on July 1, 2010. In 2015 autism coverage was amended to remove all age and dollar caps under Senate Bill 15-015, and became effective on January 1, 2017.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES COLORADO HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. The law does not apply to the following plans:
LICENSURE
No.
MEDICAID
Colorado’s Medicaid program, Health First Colorado, is fee-for-service. The fee schedule for ABA services under Colorado Medicaid can be found here.
ADULT COVERAGE OF ABA
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Colorado’s EPSDT medical necessity definition can be found in the Colorado Code of Regulations 8.076.1.8on page 74 section 8.
STATE MENTAL HEALTH PARITY
Colorado’s most recent bill that included updates to the state’s mental health parity law, Senate Bill 21-266, was enacted in 2021. A detailed description and background of Mental Health Parity laws and regulations for the state of Colorado can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
COLORADO DEPARTMENT OF INSURANCE
The Colorado Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin No. B-4.94 was issued in 2016 to address age discrimination and essential health benefits, as well as uphold the 2015 amendment.
Click here to watch a short video detailing the individuals and efforts involved in Connecticut’s autism insurance reform.
AUTISM INSURANCE REFORM
Connecticut’s autism insurance bill, Senate Bill 301, was enacted in 2009 and became effective on January 1, 2010. Bulletins HC-96 and HC-99 were published in 2014 and removed all dollar and age caps on ABA coverage.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES CONNECTICUT HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Connecticut in 2017 under sHB 7167. The Connecticut licensure board can be found here.
MEDICAID
Connecticut’s Medicaid program, Connecticut Husky Health is Fee-For-Service. The fee schedule for ABA services under Connecticut Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Colorado’s EPSDT medical necessity definition can be found in the Connecticut General Statutes Section 17b-259b.
STATE MENTAL HEALTH PARITY
Connecticut’s mental health parity law SB 301, was passed in 2009. A detailed description and background of Mental Health Parity laws and regulations for the state of Connecticut can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
CONNECTICUT DEPARTMENT OF INSURANCE
The Connecticut Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Florida’s autism insurance reform.
AUTISM INSURANCE REFORM
Florida’s autism insurance bill, Senate Bill 2654, was enacted in 2008 and became effective on April 1, 2009.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES FLORIDA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Individuals must have been diagnosed with a developmental disability at 8 years of age or younger to be eligible. Coverage is extended to those older than 18 as long as they are in high school. Coverage for the treatment of autism is subject to a maximum annual benefit of $36,000 and a lifetime limit of $200,000. The law does not apply to the following plans:
LICENSURE
No.
MEDICAID
Florida’s Medicaid program is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Florida Medicaid can be found here.
ADULT COVERAGE OF ABA
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Florida’s Coverage Policy for Behavior Analysis can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Florida’s EPSDT medical necessity definition can be found in The Florida Medicaid Definitions Manual on page 7, 2.83.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Florida can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
FLORIDA DEPARTMENT OF INSURANCE
The Florida Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Memorandum OIR-09-5M was issued in 2009 to notify changes of previous laws.
Click here to watch a short video detailing the individuals and efforts involved in Georgia’s autism insurance reform.
AUTISM INSURANCE REFORM
Georgia’s autism insurance bill, Senate Bill 118, was passed in 2015.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES GEORGIA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals under 21 years. Coverage for ABA is subject to a maximum annual benefit of $35,000. The law does not apply to the following plans:
LICENSURE
No.
MEDICAID
The fee schedule for ABA services under Georgia Medicaid can be found here.
ADULT MEDICAID COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Georgia’s EPSDT medical necessity definition can be found in Georgia Code 49-4-169.1.
STATE MENTAL HEALTH PARITY
Georgia’s mental health parity statue can be found in Georgia Code O.C.G.A. 33-24-29 . A detailed description and background of Mental Health Parity laws and regulations for the state of Georgia can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
DEPARTMENT OF INSURANCE BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Hawaii’s autism insurance reform.
AUTISM INSURANCE REFORM
Hawaii’s autism insurance bill, Senate Bill 791, was enacted in 2015 and became effective on July 1, 2015.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES HAWAII HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals under the age of 14 years and coverage is capped at $25,000 per year. However, Hawaii complies with federal MHPAEA law and does not enforce these caps.
LICENSURE
Licensure for BCBA’s was passed in Hawaii in 2021 under Senate Bill 616. The Hawaii licensure board can be found here.
MEDICAID
Hawaii’s Medicaid program, QUEST, is administered through Managed Care Organizations (MCOs). The fee schedule for ABA services under Hawaii Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Hawaii’s EPSDT medical necessity definition can be found in Hawaii Administrative Rules §17-1700.1-2 on page 42.
STATE MENTAL HEALTH PARITY
Hawaii’s mental health parity statute can be found in Hawaii Revised Statute §431M-2. A detailed description and background of Mental Health Parity laws and regulations for the state of Hawaii can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
HAWAII DEPARTMENT OF INSURANCE
The Hawaii Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Illinois’s autism insurance reform.
AUTISM INSURANCE REFORM
Illinois’ autism insurance bill, Public Law 095-1005, was enacted in 2008 and became effective on December 12, 2008.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES ILLINOIS HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism under the age of 21 years. Coverage for the diagnosis and treatment of autism is subject to a maximum annual benefit of approximately $50,000 for individual grandfathered plans. More information about Illinois’ Autism law can be found here.
LICENSURE
Licensure for BCBA’s was passed through HB4769 in May 2022 and will likely take effect in January 2024.
MEDICAID
Illinois’s Medicaid program, Application for Benefits Eligibility (ABE), is both fee-for-service and administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Illinois Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Illinois’s EPSDT Medical Necessity Definition can be found in Section 140.485 of the Healthy Kids Program paragraph d and Section 140.2 paragraph b.
STATE MENTAL HEALTH PARITY
Illinois’ mental health parity law can be found in the Illinois state statute 215 ILCS 5/370c. A detailed description and background of Mental Health Parity laws and regulations for the state of Illinois can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
Yes. In August 2021 HB2595 was passed. More information about Illinois’ general Standards of care can be found here.
ILLINOIS DEPARTMENT OF INSURANCE
The Illinois Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
The state Illinois Department of Insurance issued Bulletin 2020-04 on March 25th, 2020 to allow for services to be provided via telehealth during the COVID-19 emergency.
Click here to watch a short video detailing the individuals and efforts involved in Indiana’s autism insurance reform.
AUTISM INSURANCE REFORM
Indiana’s autism insurance bill, IC-27-8-14.2, was enacted in 2001 and became effective on July 1, 2001.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES INDIANA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.
LICENSURE
Licensure for BCBA’s was passed in Indiana in 2021 under House Bill 1516. The Indiana licensure board can be found here.
MEDICAID
Indiana’s Medicaid program is both fee-for-service and administered by MCE. The fee schedule for ABA services under Indiana Medicaid can be found here.
ADULT COVERAGE
No. However, while the State Plan continues to list an age limit of 20-years, on March 28th, 2022, in Conner Blessing v. Indiana Family and Social Services Administration (FSSA) the Court of Appeals of Indiana ruled that Medicaid is required to cover ABA for adults when medically necessary deeming that denying ABA coverage based solely upon age was discriminatory.
PROVIDER (CLINICAL AND BILLING) MANUALS
Indiana’s Medicaid clinical and billing manuals can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Indiana’s EPSDT Medical Necessity Definition can be found in the Indiana Admin. Code 405 5-2-17.
STATE MENTAL HEALTH PARITY
Indiana’s mental health parity law, SB 165, was enacted in 2016. A detailed description and background of Mental Health Parity laws and regulations for the state of Indiana can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
INDIANA DEPARTMENT OF INSURANCE
The Indiana Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 136 was issued in 2006 reiterating the requirement of health insurance coverage for treatment of Pervasive Developmental Disorders (PDDs; now “autism spectrum disorders (ASD)”). Bulletin 216 was issued in 2015 to require insurers to allow for treatment to continue during appeals processes.
Click here to watch a short video detailing the individuals and efforts involved in Iowa’s autism insurance reform.
AUTISM INSURANCE REFORM
Iowa’s autism insurance bill, HF 215, was passed in 2017 and became effective on January 1, 2018.
WHAT SERVICES ARE COVERED BY THE LAW?
Applied Behavior Analysis
DOES IOWA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to those with autism under 19 years of age. ABA coverage is subject to a maximum annual benefit of $36,000 from ages 0 to 6 years, $25,000 for ages 7 to 13, and $12,500 for ages 14 to 18 (19th birthday there is no coverage mandated). The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Iowa in 2018 under Iowa SF 192. The Iowa licensure board can be found here.
MEDICAID
Iowa’s Medicaid program is administered through Managed Care Organizations (MCOs; current are Amerigroup and Iowa Total Care). The fee schedule for ABA services under Iowa Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Iowa’s EPSDT Medical Necessity Definition can be found in the Iowa Rule 441-73.1(249A) on page 2.
STATE MENTAL HEALTH PARITY
Iowa’s mental health parity law can be found in sections 514C.22, 514C.27, and 514C.28 (autism section). A detailed description and background of Mental Health Parity laws and regulations for the state of Iowa can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
IOWA DEPARTMENT OF INSURANCE
The Iowa Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Kansas’s autism insurance reform.
AUTISM INSURANCE REFORM
Kansas’ autism insurance bill, House Bill 2744, was passed on January 1, 2014.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES KANSAS HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?Yes. Coverage is limited to individuals under 12 years of age. ABA is also limited to 1,300 hours per year for 4 years, beginning on either the date of diagnosis or January 1, 2015 (whichever is the later date). For an individual diagnosed before 5 years of age, ABA is limited to 520 hours per year until age 12. There are no treatment limits on other covered services. The law does not apply to the following plans:
BCBA LICENSURE
Licensure for BCBA’s was passed in Kansas in 2014 under The Applied Behavioral Analysis Act and was enacted in July 2016. The Kansas licensure board can be found here.
MEDICAID
Kansas’s Medicaid program, KanCare, is operated by managed care organizations (MCOs). The fee schedule for ABA services under Kansas Medicaid can be found here.
ADULT MEDICAID COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Medical Necessity is defined in Kansas’ KanCare manual.
STATE MENTAL HEALTH PARITY
Kansas has a number of laws of statues pertaining to parity. A detailed description and background of Mental Health Parity laws and regulations for the state of Kansas can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
KANSAS DEPARTMENT OF INSURANCE
The Kansas Department of Insurance website can be found here. You can submit a complaint to your state DOI here. To learn more about how and when
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Kentucky’s autism insurance reform.
AUTISM INSURANCE REFORM
Kentucky’s autism insurance bill, House Bill 159, was enacted in 2010 and became effective on January 1, 2011. In 2018, House Bill 218 amended this law to remove age and dollar caps on ABA coverage.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES KENTUCKY HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.
LICENSURE
Licensure for BCBA’s was passed in Kentucky in 2010 under House Bill 159. The Kentucky licensure board can be found here.
MEDICAID
Kentucky’s Medicaid program is managed-care-organization (MCO). The fee schedule for ABA services under Kentucky Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
The Kentucky Medicaid Provider Billing Manual for Licensed Behavioral Analysts can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Kentucky’s EPSDT Medical Necessity Definition can be found in Kentucky Code 907 3:130.
STATE MENTAL HEALTH PARITY
Kentucky’s mental health parity law, HB 268, was enacted in 2000. A detailed description and background of Mental Health Parity laws and regulations for the state of Kentucky can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
KENTUCKY DEPARTMENT OF INSURANCE
The Kentucky Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Louisiana’s autism insurance reform.
AUTISM INSURANCE REFORM
Louisiana’s autism insurance bill, Act 648, was enacted in 2008 and became effective on January 1, 2009. In 2012, Act 208 amended this law to raise the coverage age to 21 and eliminating life-time dollar caps and became effective on January 1, 2014.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES LOUISANA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism under the age of 21. Coverage for the treatment of autism is subject to a maximum annual benefit of $36,000. The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Louisiana in 2013 under Senate Bill 134 Act 351. The Louisiana licensure board can be found here.
MEDICAID
Louisiana’s Medicaid program is administered through Managed Care Organizations (MCOs). The fee schedule for ABA services under Louisiana Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
The Louisiana Provider Manual for Applied Behavior Analysis can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Louisiana’s EPSDT Medical Necessity Definition can be found in the Louisiana State Regulation 1101.
STATE MENTAL HEALTH PARITY
Louisiana has a number of laws of statues pertaining to parity. A detailed description and background of Mental Health Parity laws and regulations for the state of Louisiana can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
LOUISIANA DEPARTMENT OF INSURANCE
The Louisiana Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Maine
Click here to watch a short video detailing the individuals and efforts involved in Maine’s autism insurance reform.
AUTISM INSURANCE REFORM
Maine’s autism insurance bill, LD 1198, was enacted in 2010 and became effective on January 12, 2011. In 2014, LD 2768 amended this bill to increase the age of coverage to individuals under the age of 21.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES MAINE HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism 10 years of age or under and is subject to a maximum benefit of $36,000 per year.
LICENSURE
No.
MEDICAID
Maine’s Medicaid program, is MaineCare. The fee schedule for ABA services under Maine Medicaid is not publicly available.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
The MaineCare Benefits Manual definition for medical necessity can be found here – Ch I, Section 1, page 4, paragraph E.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Maine can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
DEPARTMENT OF INSURANCE BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Maryland’s autism insurance reform.
AUTISM INSURANCE REFORM
Maryland’s autism insurance, HB 1055, was passed in May 2012, and became effective on November 1, 2013.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES MARYLAND HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. According to the Maryland Insurance Administration, the regulations do not establish caps or limits, but instead establish a floor for coverage, that carriers may not deny based solely on the number of hours of habilitative services prescribed, which differs depending on the age of the child, consistent with the Autism Technical Advisory Group’s report.
LICENSURE
Licensure for BCBA’s was passed in Maryland in 2017 under Bill 10.58.16. The Maryland licensure board can be found here.
MEDICAID
Maryland’s Medicaid program is fee-for-service for ABA services. The fee schedule for ABA services under Maryland Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
The Maryland Medical Assistance Program Applied Behavior Analysis (ABA) Provider Manual can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The Maryland Medical Assistance Program Provider Manual’s definition for medical necessity can be found here on page 9.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Maryland can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
MARYLAND DEPARTMENT OF INSURANCE
The Maryland Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 14-07 was issued in 2014 regarding notification of new regulations to mandates.
LICENSURE
Licensure for BCBA’s was passed in Massachusetts in 2017 under Senate Bill 135. The Massachusetts licensure board can be found here.
Click here to watch a short video detailing the individuals and efforts involved in Michigan’s autism insurance reform.
AUTISM INSURANCE REFORM
Michigan’s autism insurance bills, Senate Bill 414, Senate Bill 415, and Senate Bill 981, were enacted in 2012 and became effective on October 15, 2012.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES MICHIGAN HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
On April 18, 2014, annual dollar limits in all fully insured plans were removed through No. 14-017-M. Many private insurance companies in Michigan have removed age caps on autism services because of national parity laws and recent, state-level enforcement. Under Medicaid, Applied Behavior Analysis (ABA) services is provided for children under 21 years of age.
LICENSURE
Licensure for BCBA’s was passed in Michigan in 2016 under Act 368; Senate Bill 1015 and Senate Bill 1016. The Michigan licensure board can be found here.
MEDICAID
Michigan’s Medicaid program is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Michigan Medicaid can be found here, in our library.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Michigan’s Medicaid Provider Manual can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Michigan’s EPSDT medical necessity definition is pulled from the American Academy of Pediatrics (AAP) definition of medical necessity. The Michigan Provider Manual’s medical necessity definition can be found hereon page 676 (section 1, page 1 of the EDPST section of the manual).
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Michigan can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
MICHIGAN DEPARTMENT OF INSURANCE
The Michigan Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 2022-10-INS was issued in 2022 to remove age caps from private insurance plans.
LICENSURE
Licensure for BCBA’s was passed in Mississippi in 2015 under House Bill 885. The Mississippi licensure board can be found here.
LICENSURE
Licensure for BCBA’s was passed in Missouri in 2010 under House Bills 1311 and 1341. The Missouri licensure board can be found here.
Click here to watch a short video detailing the individuals and efforts involved in Montana’s autism insurance reform.
AUTISM INSURANCE REFORM
Montana’s autism insurance bill, Senate Bill 234, was enacted in 2009 and became effective on January 1, 2010.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES MONTANA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.
LICENSURE
Licensure for BCBA’s was passed in Montana in 2017 under Senate Bill 193. The Montana licensure board can be found here.
MEDICAID
Montana’s Medicaid program is fee-for service. The fee schedule for ABA services under Montana Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Montana’s Medicaid Applied Behavior Analysis Services Manual can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Montana’s medically necessity definition can be found in Montana Rule ARM 37.82.102 (18).
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Montana can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
MONTANA DEPARTMENT OF INSURANCE
The Montana Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Nebraska
Click here to watch a short video detailing the individuals and efforts involved in Nebraska’s autism insurance reform.
AUTISM INSURANCE REFORM
Nebraska’s autism insurance bill, Legislative Bill 254, was enacted in 2014 and became effective on January 1, 2015.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES NEBRASKA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism less than age 21. Behavioral health therapies, including ABA, are limited to 25 hours per week. The law does not apply to the following plans:
BCBA LICENSURE
No.
MEDICAID
Nebraska’s Medicaid program is administered through MCO’s. The fee schedule for ABA services under Nebraska Medicaid is not publicly available.
ADULT MEDICAID COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
The Nebraska Department of Health and Human Services Division of Developmental Disabilities Policy Manual can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Nebraska DHHS’ medical necessity definition can be found here on page 2.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Nebraska can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NEBRASKA DEPARTMENT OF INSURANCE
The Nebraska Department of Insurance website can be found here. You can submit a complaint to your state DOI here. To learn more about how and when
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in Nevada’s autism insurance reform.
AUTISM INSURANCE REFORM
Nevada’s autism insurance bill, Assembly Bill 162, was enacted in 2009 and became effective on January 1, 2011.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES NEVADA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism under the age of 18 (or until age 22 if still enrolled in high school). Coverage for ABA is subject to a maximum annual benefit of $36,000. The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Nevada in 2018. The Nevada licensure board can be found here.
MEDICAID
Nevada’s Medicaid program is both fee-for-service and administered by Managed Care Organizations (MCOs). Instructions for how to access the fee schedule for ABA services under Nevada Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Nevada’s Medicaid billing manual for Applied Behavior Analysis can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The Nevada Medicaid Services Manual’s medical necessity definition can be found here on page 34.
STATE MENTAL HEALTH PARITY
In 2009, Nevada passed SB426 to align the state with federal MHPAEA laws. In 2014 AB425 was passed to further bring Nevada into compliance. A detailed description and background of Mental Health Parity laws and regulations for the state of Nevada can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NEVADA DEPARTMENT OF INSURANCE
The Nevada Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DEPARTMENT OF INSURANCE BULLETINS
None.
New Hampshire
Click here to watch a short video detailing the individuals and efforts involved in New Hampshire’s autism insurance reform.
AUTISM INSURANCE REFORM
New Hampshire’s autism insurance bill, House Bill 569, was enacted in 2010 and became effective on January 1, 2011.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES NEW HAMPSHIRE HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage for ABA is limited to individuals ages 0 to 21 years and is subject to annual dollar caps. For individuals 0 to 12 years of age, coverage is capped at $36,000 per year. For individuals 12 to 21 years of age, coverage is capped at $27,000 per year. The law does not apply to the following plans:
BCBA LICENSURE
No.
MEDICAID
The fee schedule for ABA services under New Hampshire Medicaid can be found here.
ADULT MEDICAID COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
New Hampshire’s Medicaid Provider Manuals can be found here.
New Hampshire’s Medicaid Billing Manuals can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The New Hampshire Regulations’ medical necessity definition can be found here.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of New Hampshire can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NEW HAMPSHIRE DEPARTMENT OF INSURANCE
The New Hampshire Department of Insurance website can be found here. You can submit a complaint to your state DOI here. To learn more about how and when to submit a complaint to the Department of Insurance, visit our Regulatory Resource page.
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in New Jersey’s autism insurance reform.
AUTISM INSURANCE REFORM
New Jersey’s autism insurance bill, P.L.2006, c. 115, was enacted on August 13, 2009, and became effective on February 9, 2010. A 2010 bulletin removed dollar caps on coverage.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES NEW JERSEY HAVE CAPS ON ABA COVERAGE?
Yes. Coverage for ABA is limited to individuals with autism under 21 years of age.
BCBA LICENSURE
Licensure for BCBA’s was passed in New Jersey in 2020. The licensure process is currently open to public comment. More information on BCBA licensure in New Jersey can be found here.
MEDICAID
New Jersey’s Medicaid program both FFS and MCO. The fee schedule for ABA services under New Jersey Medicaid can be found here.
Medicaid funding for ABA in NJ is available in two state programs.
ADULT MEDICAID COVERAGE
Yes. See above.
PROVIDER (CLINICAL AND BILLING) MANUALS
The New Jersey Policies and Procedures Manual for the Division of Developmental Disabilities can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The New Jersey State Regulations’ medical necessity definition can be found here on page 15.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of New Jersey can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NEW JERSEY DEPARTMENT OF INSURANCE
The New Jersey Department of Banking and Insurance website can be found here. You can submit a complaint to the New Jersey DOI here. To learn more about how and when to submit a complaint to the Department of Insurance, visit our Regulatory Resource page.
DOI BULLETINS
See above.
Click here to watch a short video detailing the individuals and efforts involved in New Mexico’s autism insurance reform.
AUTISM INSURANCE REFORM
New Mexico’s autism insurance bill, Senate Bill 39, was enacted in 2009 and became effective on January 1, 2010. In 2013, House Bill 22 added coverage for state employees and became effective on January 1, 2015. In 2019, House Bill 322 removed all age and dollar caps from the law and became effective on June 15, 2019.
WHAT SERVICES ARE COVERED BY LAW?
DOES NEW MEXICO HAVE ANY CAPS ON ABA COVERAGE?
No.
LICENSURE
No.
MEDICAID
New Mexico’s Medicaid program is administered by Managed Care Organizations (MCOs; Blue Cross Blue Shield, Presbyterian, and Western Sky). The fee schedule for ABA services under New Mexico Medicaid can be found here.
ADULT COVERAGE
Yes. In 2019, House Bill 322 removed all age and dollar caps from the law and became effective on June 15, 2019.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
New Mexico’s medical necessity definition can be found in New Mexico Code 8.302.1.7.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of New Mexico can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NEW MEXICO DEPARTMENT OF INSURANCE
The New Mexico Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin No. 2015-013 was issued in March 2015 expanding coverage to small group and individual insurance plans.
Click here to watch a short video detailing the individuals and efforts involved in New York’s autism insurance reform.
AUTISM INSURANCE REFORM
New York’s autism insurance bills, A8512 and S5845 were enacted in 2011 and became effective on November 1, 2012.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES NEW YORK HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.
BCBA LICENSURE
Licensure for BCBA’s was passed in New York in 2014. The New York licensure board can be found here.
MEDICAID
New York’s Medicaid program is administered through managed care organizations (MCOs). The fee schedule for ABA services under New York Medicaid can be found here.
ADULT MEDICAID COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
New York’s Clinical Practice Guideline on Autism/Pervasive Developmental Disorders: Assessment and Intervention for Young Children (Age 0-3 years) can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The New York state law’s medical necessity definition can be found here on page 6.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of New York can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NEW YORK DEPARTMENT OF INSURANCE
The New York Department of Financial Services website can be found here. You can submit a complaint to your state DOI here. To learn more about how and when to submit a complaint to the Department of Insurance, visit our Regulatory Resource page.
DOI BULLETINS
Insurance Circular Letter No. 6 (2014)
Click here to watch a short video detailing the individuals and efforts involved in North Carolina’s autism insurance reform.
AUTISM INSURANCE REFORM
North Carolina’s autism insurance bill, Senate Bill 676, was enacted on October 15, 2015, and became effective on July 1, 2016.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES NORTH CAROLINA HAVE CAPS ON ABA COVERAGE?
Yes. Coverage for adaptive behavior treatment is limited to individuals under 19 years of age and is capped at $40,000 per year. The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in North Carolina in 2021 under Senate Bill 103. The North Carolina licensure board can be found here.
MEDICAID
North Carolina’s Medicaid program is administered by Managed Care Organizations (MCO). The fee schedule for ABA services under North Carolina Medicaid can be found here and here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
The North Carolina Medicaid Research-Based Behavioral Health Treatment for Autism Spectrum Disorder Manual can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The North Carolina EPSDT policies’ definition for medical necessity can be found here (page 1 paragraph 2).
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of North Carolina can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
NORTH CAROLINA DEPARTMENT OF INSURANCE
The North Carolina Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
LICENSURE
Licensure for BCBA’s was passed in North Dakota in 2020 under Senate Bill 2236. The North Dakota licensure board can be found here.
Click here to watch a short video detailing the individuals and efforts involved in Ohio’s autism insurance reform.
AUTISM INSURANCE REFORM
Ohio’s autism insurance bill, House Bill 463 (Sec. 1751.84), was enacted in 2017.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES OHIO HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under 21 years. Benefits are subject to maximum annual or weekly limits.
LICENSURE
No. However, Ohio does have a certification for BCBA’s under the Ohio Psychology Licensing Board – Certified Ohio Behavior Analyst (COBA). The COBA certification for BCBA’s was passed in Ohio in 2014 under HB 59. The Ohio licensure board can be found here.
MEDICAID
Ohio offers most Medicaid services through managed care organizations (MCO) with some of the population till on fee-for-service (FFS) Medicaid. The suggested fee schedule for ABA services under Ohio Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Ohio’s ABA Provider manual will be released this fall (2022).
EPSDT MEDICAL NECESSITY DEFINITION
Ohio’s EPSDT Medical Necessity Definition can be found in Ohio State Code 5160-1-01.
STATE MENTAL HEALTH PARITY
Ohio’s mental health parity law, Senate Bill 284, was enacted in 2021. A detailed description and background of Mental Health Parity laws and regulations for the state of Ohio can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
OHIO DEPARTMENT OF INSURANCE
The Ohio Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 2018-05 was issued in 2018 regarding obligations for short-term, limited-duration policies.
Click here to watch a short video detailing the individuals and efforts involved in Oklahoma’s autism insurance reform.
AUTISM INSURANCE REFORM
Oklahoma’s autism insurance bill, House Bill 2962, was enacted in 2016 and became effective on November 1, 2016. In August 2021, LH Bulletin No. 2021-03 was issued to removed dollar, age, and dollar caps.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES OKLAHOMA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Oklahoma in 2009 under SB 135. The Oklahoma licensure board can be found here.
MEDICAID
Oklahoma’s Medicaid program, SoonerCare, is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Oklahoma Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
A general Provider Billing and Procedures Manual for Oklahoma can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
Oklahoma’s medical necessity definition can be found in Oklahoma Rule 317:30-3-1 paragraph f.
STATE MENTAL HEALTH PARITY
In 2020 Oklahoma passed SB 1718 which brough Oklahoma into compliance with the federal MHPAEA law. A detailed description and background of Mental Health Parity laws and regulations for the state of Oklahoma can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
OKLAHOMA DEPARTMENT OF INSURANCE
The Oklahoma Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 2021-03 was issued in 2021 regarding removing age caps and other federal MHPAEA violations.
LICENSURE
Licensure for BCBA’s was passed in Oregon in 2021 under Senate Bill 358. The Oregon licensure board can be found here.
Click here to watch a short video detailing the individuals and efforts involved in Pennsylvania’s autism insurance reform.
AUTISM INSURANCE REFORM
Pennsylvania’s autism insurance bill, House Bill 1150, was enacted in 2008 and became effective on July 1, 2009.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES PENNSYLVANIA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage for the treatment of autism is limited to individuals under 21 years of age and is subject to a maximum benefit of $36,000. The law does not apply to the following plans:
LICENSURE
No.
MEDICAID
Pennsylvania’s Medicaid program, Medical Assistance (MA), is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Pennsylvania Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Billing and clinical guidelines for Pennsylvania Medicaid can be found here.
EPSDT Medical Necessity Definition
Pennsylvania’s medical necessity definition can be found in Pennsylvania Code 1101.21a.
STATE MENTAL HEALTH PARITY
In 2010 Pennsylvania passed SB237 requiring insurers to comply with the federal MHPAEA law. A detailed description and background of Mental Health Parity laws and regulations for the state of Pennsylvania can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
PENNSYLVANIA DEPARTMENT OF INSURANCE
The Pennsylvania Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin 2022-04 was issued in 2022 regarding the increase in maximum benefit for autism spectrum disorders.
Click here to watch a short video detailing the individuals and efforts involved in Rhode Island’s autism insurance reform.
AUTISM INSURANCE REFORM
Rhode Island’s autism insurance bills, H 5275 Sub A (2011) and H 7165 Sub A (2012), were enacted in 2011 and became effective on January 1, 2012.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES RHODE ISLAND HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under the age of 15 years. Coverage for Applied Behavior Analysis is subject to a maximum benefit of $32,000 per year. The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Rhode Island in 2012 under S 2559. The Rhode Island licensure board can be found here.
MEDICAID
Rhode Island’s Medicaid program is fee-for-service. The fee schedule for ABA services under Rhode Island Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
The Rhode Island Provider Manual’s medical necessity definition can be found here (page 10).
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Rhode Island can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
RHODE ISLAND DEPARTMENT OF INSURANCE
The Rhode Island Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
Click here to watch a short video detailing the individuals and efforts involved in South Carolina’s autism insurance reform.
AUTISM INSURANCE REFORM
South Carolina’s autism insurance bill, S20, was enacted in 2007 and became effective on July 8, 2008.
WHAT SERVICES ARE COVERED BY THE LAW?
Coverage is limited to treatment that is prescribed by the insured’s treating medical doctor in accordance with a treatment plan
DOES SOUTH CAROLINA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under the age of 16 years, and the individual must have been diagnosed with autism spectrum disorder by age eight or younger. Coverage for ABA is subject to a maximum benefit of $50,000 per year. The law does not apply to the following plans:
LICENSURE
No.
MEDICAID
South Carolina’s Medicaid program, Healthy Connections, is both fee-for-service and administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under South Carolina Medicaid can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
South Carolina’s EPSDT medical necessity definition can be found here.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of South Carolina can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
SOUTH CAROLINA DEPARTMENT OF INSURANCE
The South Carolina Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
Bulletin No. 2021-07 was issued in 2021 to increase the maximum benefit for autism spectrum disorders.
LICENSURE
Licensure for BCBA’s was passed in South Dakota in 2016 under Chapter 36-38; Rule 20-85. The South Dakota licensure board can be found here.
LICENSURE
Licensure for BCBA’s was passed in Tennessee in 2013 under House Bill 1279. The Tennessee licensure board can be found here.
Texas requires meaningful coverage for autism under state-regulated plans.
Texas's autism insurance bill, SB 946, was enacted in 2011 and became effective on July 1, 2012.
TO WHICH PLAN DOES THE STATE AUTISM INSURANCE LAW APPLY?
Individual Plans - YES
Fully Insured Large Group Plans - YES
Fully Insured Small Group - YES
WHAT SERVICES ARE COVERED BY LAW?
Behavioral health treatment (e.g. Applied Behavior Analysis) - for purposes of the law, “behavioral health treatment” is defined as “professional services and treatment programs, including ABA and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual.” Treatment must be prescribed by a licensed physician and provided by qualified autism service provider, qualified autism service professional or qualified autism service paraprofessional.
DOES TEXAS HAVE CAPS ON ABA COVERAGE?
Yes. As of September 1st, 2013, there is no age limit on coverage for the treatment of autism. However, in order to be eligible for coverage, the individual must have been diagnosed with autism prior to age 10.
WHERE CAN I FIND MORE DETAILS ABOUT THE TEXAS AUTISM INSURANCE LAW?
A copy of SB 946 as enrolled can be found here.
LICENSURE
Licensure for BCBA’s was passed in Texas in 2017 under Senate Bill 589. The Texas licensure board can be found here.
Click here to watch a short video detailing the individuals and efforts involved in Utah’s autism insurance reform.
AUTISM INSURANCE REFORM
Utah’s autism insurance bill, Senate Bill 57, was enacted in 2014 and became effective on January 1, 2016. In 2019, Senate Bill 95 was passed and removed age and dollar caps from coverage.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES UTAH HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. The law does not apply to the following plans:
LICENSURE
Licensure for BCBA’s was passed in Utah in 2015 under SB 246. The Utah licensure board can be found here.
MEDICAID
Utah’s Medicaid program is fee-for-service. The fee schedule for ABA services under Utah Medicaid is not publicly available.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
Utah’s Medicaid Provider Manual for autism can be found here.
EPSDT MEDICAL NECESSITY DEFINITION
The Utah Medicaid Provider Manual contains a medical necessity definition on page 39.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Utah can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
UTAH DEPARTMENT OF INSURANCE
The Utah Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
No.
Click here to watch a short video detailing the individuals and efforts involved in Vermont’s autism insurance reform.
AUTISM INSURANCE REFORM
Vermont’s autism insurance bill, S. 262, was enacted in 2010 and became effective on July 1, 2011 In 2012, S. 223 amended this bill by raising the age cap and requiring the same benefits be provided by the state Medicaid program or any other public health care assistance program.
WHAT SERVICES ARE COVERED BY THE LAW?
DOES VERMONT HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under age 21.
LICENSURE
Licensure for BCBA’s was passed in Vermont in 2015 under S.136. The Vermont licensure board can be found here.
MEDICAID
The fee schedule for ABA services under Vermont Medicaid can be found here. An explanation of Vermont’s payment model can be found here.
ADULT COVERAGE
No.
PROVIDER (CLINICAL AND BILLING) MANUALS
EPSDT MEDICAL NECESSITY DEFINITION
Vermont’s medical necessity definition can be found in Vermont Health Care Administrative Rules.
STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Vermont can be found here.
DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.
VERMONT DEPARTMENT OF INSURANCE
The Vermont Department of Insurance website can be found here. You can submit a complaint to your state DOI here.
DOI BULLETINS
None.
LICENSURE
Licensure for BCBA’s was passed in Virginia in 2012 under House Bill 1106. The Virginia licensure board can be found here.
LICENSURE
Licensure for BCBA’s was passed in Washington in 2015 under Substitute SB 5488. The Washington licensure board can be found here.
LICENSURE
Licensure for BCBA’s was passed in Wisconsin in 2009 under Senate Bill 667. The Wisconsin licensure board can be found here.
LICENSURE
Licensure for BCBA’s was passed in Wyoming in 2022. The Wyoming licensure board can be found here.
To the best of our ability, the information above is accurate and up to date, but it is up to the consumer to investigate fully before making any decisions regarding health care coverage.
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