Beyond the B.A.S.I.C.S. Blog
VA Autism Law HB 2467/SB 1062 Fact Sheet
November 16, 2011
WHAT DOES THE LAW DO?
– It requires state-regulated health plans to provide coverage for the diagnosis and treatment of autism spectrum disorders for children aged 2 through 6.
WHEN DOES THE LAW TAKE EFFECT?
– The law effects all state-regulated insurance policies issued or renewed on/after January 1, 2012.
WILL MY INSURANCE COMPANY HONOR THE NEW LAW?
– The law applies ONLY to state-regulated insurance. If your insurance plan is self-funded, regulated by ERISA law, or regulated by federal law only, YOU WILL NOT BE COVERED under the new law. Call your insurance provider to check eligibility.
– If your child has been diagnosed or treated with/for autism spectrum disorders in the past, eligible insurance companies will no longer be able to terminate or refuse to deliver coverage.
HOW DO I KNOW IF MY CHILD QUALIFIES FOR SERVICES?
– Services covered under the law must be deemed “medically necessary” by a licensed physician or psychologist, and must be prescribed, provided, or ordered as such.
– The law DOES NOT COVER services provided under individualized family service plans, IEPs, or individualized service plans.
WHAT DOES “MEDICALLY NECESSARY” MEAN?
– According to the text of the new law, a “medically necessary” treatment is one that is based on evidence and “reasonably expected” to do one of the following:
o Prevent the onset of an illness or disability
o Reduce the effects of an illness or disability
o Help achieve and/or maintain maximum functionality in performing daily activities
MY CHILD DOESN’T HAVE AUTISM. AM I STILL COVERED?
– The law provides coverage for “any pervasive developmental disorder,” including:
o Autistic Disorder
o Asperger’s Syndrome
o Rett Syndrome
o Childhood Disintegrative Disorder
– Eligible disorders will be determined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
WHICH DIAGNOSTIC SERVICES WILL BE COVERED?
– Evaluations (including neuropsychiatric evaluations)
– Genetic testing
– “other [medically necessary] testing to determine… autism spectrum disorders”
WHICH BEHAVIORAL HEALTH SERVICES WILL BE COVERED?
– Professional counseling
– Guidance services and treatment programs
– ABA when it is provided by or supervised by a Board Certified Behavior Analyst
HOW MUCH ABA WILL BE COVERED?
– The maximum yearly allowance for ABA is $35,000. Your insurance company may provide a different amount of coverage; call your provider to find out.
WHICH OTHER SERVICES WILL BE COVERED?
– Pharmaceutical care
– Psychiatric care
– Psychological care
– Therapeutic care, including:
o Speech Therapy
o Occupational Therapy
o Physical Therapy
o Clinical Social Workers
WHERE CAN I GET MORE INFORMATION?
– Attend an informational meeting on Saturday, December 3rd, 2011 in Richmond, VA. E-mail firstname.lastname@example.org for details.
– Visit http://www.autismvotes.org/
Melissa Ruiz, BCaBA
BASICS ABA Therapy, LLC