Pennsylvania Autism Insurance Act Fact Sheet from the Department of Public Welfare:
The Autism Insurance Act:
Requires many private health insurance companies to cover the cost of diagnostic assessment and treatment of autism spectrum disorder and services for children under the age of 21, up to $36,000 per year;
Requires the Pennsylvania Department of Public Welfare, DPW, to cover the cost of services for individuals who are enrolled in the Medical Assistance program and do not have private insurance coverage, or for individuals whose costs exceed $36,000 in one year; and
Requires the Pennsylvania Department of State to license professional behavior specialists who provide services to children.
Who is covered by the Autism Insurance Act?
Children or young adults under age 21 with a diagnosis of an autism spectrum disorder who:
Are covered under an employer group health insurance policy (including HMOs and PPOs) that has more than 50 employees and the policy is not a "self-insured" or "ERISA" policy;
Are on Medical Assistance; or
Are covered by Pennsylvania’s Children’s Health Insurance Program, CHIP, or adultBasic.
What does the Autism Insurance Act cover?
Diagnostic assessment and treatment of autism spectrum disorders, which include:
Prescription drugs and blood level tests;
Services of a psychiatrist and/or psychologist (direct or consultation);
Applied behavioral analysis; and
Other rehabilitative care and therapies, such as speech and language pathologists, occupational and physical therapists.
Treatment Requirements:
Must be for an autism spectrum disorder;
Must be medically necessary;
Must be identified in a treatment plan;
Must be prescribed, ordered or provided by a licensed physician, licensed physician assistant, licensed psychologist, licensed clinical social worker or certified registered nurse practitioner; and
Must be provided by an autism service provider or a person, entity or group that works under the direction of an autism service provider.
Read Autism Spectrum Disorders Mandated Benefits Review Panel Report
This report, published June 18, 2008, details the cost effectiveness of autism insurance coverage and, while prepared specifically for the Commonwealth of Pennsylvania, this analysis can be presented as evidence in all states.
Report Summary Conclusion: “The evidence submitted to the Pennsylvania Health Care Cost Containment Commission is sufficient to evaluate the impact of the HB 1150 mandate. The analyses and research papers support a finding of marginal premium increase costs of approximately $1 PM/PM attributable to the ASD benefit. These cost increases are modest relative to: ongoing insurance cost increases; estimated cost offsets for families and the Commonwealth; and better results for children and youth with ASD. The clinical and cost effectiveness research studies provided indicate that improvements in clinical and role functioning and quality of life can be anticipated for those children and youth with ASD who use evidence based behavioral therapies, including Applied Behavioral Analysis.”
Media:
Listen to radio ads sponsored by Autism Speaks in support of HB 1150:
Above: Parents gather for HB 1150 Rally in Harrisburg on June 25, 2008
Above: Miss Pennsylvania and PA CAC, Rachel Brooks (Right), and other volunteers gather signatures at the June 2008 Pittsburg Walk
Above:Bob Wright (center) speaks at the introduction of the HB 1150 on April 18, 2007, as Suzanne Wright (left) and Pennsylvania House Speaker Dennis O'Brien look on.
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Autism Speaks Applauds Pennsylvania Governor Ed Rendell For Signing Into Law The Strongest Autism Insurance Reform Legislation In The Nation
