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House Bill 1150 was signed into law on July 9, 2008 and became Act 62, the Autism Insurance Act. This Act will impose changes for coverage of autism services through the Medical Assistance program and private health insurers. Act 62 goes into effect on July 1, 2009.
Act 62 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;
- 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
- The Pennsylvania Department of State to license professional behavior specialists and to establish minimum licensure qualifications for them.
According to The Department of Public Welfare’s (DPW) website, this Act covers 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.
Any of the pervasive development disorders defined in the current edition of the Diagnostic and Statistical Manual (DSM) are covered. These include: autistic disorder, Asperger Syndrome, Rett Syndrome, Childhood Disintegration Disorder and Pervasive Development Disorder (Not Otherwise Specified).
Services covered under this act are the diagnostic assessments and treatments 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.
The DPW states that 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.
To enforce the law, the Pennsylvania Insurance Department is requiring that all health insurance companies, conducting business in Pennsylvania, submit a compliance report by January 2011.
For more information, please visit: http://www.dpw.state.pa.us/ServicesPrograms/Autism/Act62/ or
To view the Act 62: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=HTM&sessYr=2007&sessInd=0&billBody=H&billTyp=B&billNbr=1150&pn=4133
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Comments
The law became effective 7/1/09. But when does the private insurance stars covering for services of Act 62. I called my private insurance and was told that Act 62 benefits will not be effective until renewal time of my insurance.
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