Massachusetts Autism News:
January 20 Update
ARICA Webinar Scheduled for Feb. 2
WALTHAM, MA -- The Autism Insurance Resource Center has scheduled a February 2 webinar entitled “ARICA – The Second Year” regarding the new Massachusetts autism insurance reform law. The webinar is scheduled for 10 to 11:30 am. To register, contact info@disabilityinfo.org
The resource center is part of the Eunice Kennedy Shriver Center at the University of Massachusetts Medical School.
Massachusetts Becomes the 23rd State to Enact Autism Insurance Reform
NEW YORK, NY (August 4, 2010) -- Autism Speaks joined Massachusetts families and other autism advocacy organizations in applauding Governor Deval Patrick yesterday for signing the House Bill 4935 (An Act Relative to Insurance Coverage for Autism Spectrum Disorder) requiring private health insurance plans to provide coverage of evidence-based, medically necessary autism therapies for people of all ages.
The bill, which was sponsored by Senate Majority Leader Frederick Berry (2nd Essex District), and State Representative L’Italien (18th Essex District), Vice Chair of Ways and Means, ends private insurance companies’ discrimination against individuals of all ages diagnosed with an autism spectrum disorder by requiring coverage of medically necessary autism treatments, including evidence-based behavioral health treatments.
“We thank Governor Patrick for signing ARICA into law,” said Peter Bell, Autism Speaks executive vice president of programs and services. “This enactment allows Massachusetts to join the growing number of states that have recognized the unfair and unreasonable burden being imposed on individuals diagnosed with autism and their families.”
Governor Patrick signed the bill before hundreds of families at Fenway Park on Tuesday, making Massachusetts the twenty-third state to pass such legislation.
“I am proud that Massachusetts now has one of the most comprehensive autism coverage laws in the nation," said Governor Patrick. "This bill offers needed relief for individuals and families struggling to pay for the services they need."
"Autism insurance coverage represents a systemic change in how many people with autism in Massachusetts will access critical treatment," said Amy Weinstock, Insurance Committee Chair for Advocates for Autism of Massachusetts (AFAM). "We are grateful to the members of our community for their tireless advocacy and for the amazing support of Autism Speaks. We are incredibly fortunate to have Representative L'Italien and Senator Berry as our champions and we thank Governor Patrick for making autism insurance coverage a reality for our families.”
In many states, insurers explicitly exclude coverage of evidence-based, medically necessary autism therapies from policies, which places a significant financial burden on individuals with autism and their families. In addition to Massachusetts, twenty-two other states – Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, and Wisconsin – have enacted autism insurance reform bills.
Autism Speaks Joins Massachusetts Autism Community In Applauding The Senate For Unanimously Passing H. 4935 (July 29, 010)
Autism Speaks, State Representative L’italien, AFAM Join Massachusetts Autism Community In Calling For An End To Autism Insurance Discrimination (October 21, 2009)
Autism Insurance Reform Bill Introduced in Massachusetts (January 22, 2009)
FAQs On the Massachusetts Autism Insurance Reform Bill (H.4935, ARICA)
What does ARICA do?
ARICA requires health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder, which currently affects 1 in every 110 individuals. Read the text of the law HERE.
When does ARICA go into effect?
ARICA goes into effect January 1, 2011, but implementation will be based on each policy’s specific renewal date. If you have insurance under a policy that is subject to ARICA (see below), the coverage must be provided when the policy renews on or after January 1, 2011, meaning it will go into effect the date that your company’s insurance plan renews annually.
What types of policies does ARICA cover?
Massachusetts legislation can only affect certain types of health care policies, so coverage under ARICA will depend on the type of policy you have. Private insurers, employees and retirees under the state plan, hospital service plans and HMOs would all be required to comply with the mandate. Self-funded plans are regulated by ERISA – which is federal law. This includes many of the State’s largest employers. ERISA plans are not subject to State laws and not required to provide coverage under ARICA.
How can I find out if I have coverage under ARICA?
Contact your employer to verify that your policy is subject to the new law, and if so, what annual date your group policy renews. Even if your company is regulated by ERISA, they may as practice comply with State laws. In addition, there is language in the recently enacted federal health care reform that will eventually cover autism treatment. We will be providing more information for employees covered under ERISA plans – in the meantime, you can access general information about self insured plans HERE.
Are individuals or family members covered for services under MassHealth or CommonHealth?
Unfortunately, there is no coverage required under ARICA. However it is possible for families with MassHealth or CommonHealth to access some treatments through EPSDT. Families covered by MassHealth or CommonHealth, with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through DDS. – Consult DDS to find out the next application window.
Is there a limit to the amount of the coverage?
No. The diagnosis and treatment of Autism Spectrum Disorders will not be subject to any annual or lifetime dollar or unit of service limitation on coverage which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.
Is there an age limit to this coverage?
There is no age limit.
What treatments are covered under ARICA?
The law covers the following care prescribed, provided, or ordered for an individual diagnosed with one of the Autism Spectrum Disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:
-
Habilitative or Rehabilitative Care – this includes professional, counseling and guidance services and treatment programs, including but not limited to, applied behavior analysis supervised by a board certified behavior analyst, that are necessary to develop, maintain and restore, to the maximum extent practicable, the functioning of an individual.
-
Pharmacy care -medications prescribed by a licensed physician and health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the insurance policy for other medical conditions.
-
Psychiatric care - direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.
-
Psychological care -direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.
-
Therapeutic care - services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers.
How are educational services affected?
ARICA does not affect educational services provided under an IFSP, IEP or ISP. Insurers are not required to pay for in-school services. Conversely, under IDEA, schools may not require parents to access private insurance for services that are part of FAPE.
Download FAQs on the Massachusetts autism insurance reform law (ARICA)
|
