What does Autism Insurance Act (Act 62) do?
Broadly speaking, Act 62 does three main things:
- It requires many private insurers to begin covering the costs of diagnostic assessments for autism and of services for individuals with autism who are under the age of 21, up to $36,000 per year;
- It requires the Pennsylvania Department of Public Welfare to cover those costs for eligible individuals who have no private insurance coverage, or for individuals whose costs exceed $36,000 that year; and
- It requires the Pennsylvania Department of State to license professional behavior specialists and to establish minimum licensure qualifications for them.
The specific terms and provisions of this law are described in more detail in this FAQ document.
When does the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect?
Most sections of the Autism Insurance Act go into effect July 1, 2009, including the provisions that require many insurers to cover services for autism spectrum disorder.
Once the Autism Insurance Act goes into effect, will my employer-provided health insurance be required to cover my child’s autism services?
Employers with at least 51 employees and that offer group health insurance coverage are required to offer autism services for children under age 21. If your employer has 50 or fewer employees and you are enrolled in Medical Assistance, the Department of Public Welfare will continue to provide your child’s autism services, through the Medical Assistance program. Your child may also be able to receive services through CHIP or adultBasic, if they qualify.
What happens if we get our insurance through a “small group” employer (50 or fewer) or through an employer that self-insures?
The Department of Public Welfare will provide coverage for your child’s autism services as they currently do through the Medical Assistance program.
Are there limits on what our private insurance is going to be required to cover?
Insurance companies are not required to cover the costs of services that fall outside the mandated services defined in Act 62. For those mandated services though, there will be no limits on the number of visits to a provider. There is a $36,000 annual cap on coverage, after which DPW will pick up coverage. Beginning April 1, 2012, the cap will be adjusted upwards annually to account for inflation. Coverage may be subject to other limitations and exclusions as long as they are allowed under Act 62.
More information can be found at http://www.dpw.state.pa.us/ServicesPrograms/Autism/Act62/003678243.htm
How will the law be enforced?
The Pennsylvania Insurance Department has strong regulatory powers to enforce the law. In addition, each health insurance company doing business in Pennsylvania is required to submit a compliance report to the Insurance Department by January 2011.
