Autism Healthcare Information by State


Below, the green map reflects the efforts of many to pass autism insurance reform in all 50 states in the last decade. By clicking on each state, you can see all details related to a given state's insurance law as well as other relevant insurance information for each state including BCBA licensure, Medicaid, mental health parity, and more.

Click on Select a state below to view insurance details of its state-regulated autism insurance coverage.

Alabama

Click here to watch a short video detailing the individuals and efforts involved in Alabama’s autism insurance reform.

AUTISM INSURANCE REFORM

Alabama’s autism insurance bill, House Bill 284, was enacted in 2017 and became effective on October 1, 2017.

WHAT SERVICES ARE COVERED BY LAW?

  • Behavioral health treatment, including applied behavior analysis
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Speech Therapy, Occupational Therapy, Physical Therapy
  • Screening, diagnosis, and treatment of autism spectrum disorder

DOES ALABAMA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Per statute, coverage is limited to individuals under 18 years of age. Coverage for applied behavior analysis is subject to cap of $40,000 per year between ages 0 to 9 years, a $30,000 per year between ages 10 to 13 years, and $20,000 per year between ages 14 to 18 years.

However, upon implementation of HB284, BCBS-AL acknowledged that the monetary caps violated MHPAEA and would not be enforcing them (see memo in library).

Further, in response to an inquiry regarding enforcement of MHPAEA as it relates to implementation of the statutory caps by other carriers, a representative from the legal division of the Alabama Department of insurance stated the following:

“In an effort to make an educated decision on the fact situation that you gave us, the Department has reached out to our top carriers to ascertain their methods with dealing with the Autism law in Alabama as well as​ the Mental Health Parity and Addiction Equity Act ("MHPAEA”).  The carriers informed the Department that they are aware of (MHPAEA) and its requirements.  Those carriers stated that their plans do not contain age limit or dollar caps for Autism services and are complaint with MHPAEA.”[1]

The law does not apply to the following plans:

  • Fully Insured Small Group Grandfathered Plans
  • Fully Insured Small Group Non-Grandfathered Plans
  • Individual Non-Grandfathered Plans

LICENSURE
Licensure for BCBA’s was passed in Alabama in 2014. The Alabama licensure board can be found here.

MEDICAID
Alabama’s Medicaid program is fee-for-service. The fee schedule for ABA services under Alabama Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Alabama’s Medicaid Provider Manual can be found here.
  • Alabama’s Medicaid Provider Manual (Chapter 37 – Therapy) can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Alabama’s EPSDT medical necessity definition can be found in the State Administrative Code 560-x-11-.14 on page 1, paragraph 1 and in the Alabama Medicaid Provider Manual (above) on page 139.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Alabama can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

ALABAMA DEPARTMENT OF INSURANCE
The Alabama Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

[1] M.L. Wasmer (personal communication, June 25, 2021)

Alaska

Click here to watch a short video detailing the individuals and efforts involved in Alaska’s autism insurance reform.

AUTISM INSURANCE REFORM
Alaska’s autism insurance bill, Senate Bill 74, was enacted in 2012 and became effective on January 1, 2013.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Applied Behavior Analysis and other structural behavioral therapies
  • Speech Therapy, Occupational Therapy, Physical Therapy

DOES ALASKA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under 21 years of age. There are no annual dollar caps on coverage.

LICENSURE
Licensure for BCBA’s was passed in Alaska in 2014 under House Bill 361. The Alaska licensure board can be found here.

MEDICAID
Alaska’s Medicaid program is fee-for-service. The fee schedule for ABA services under Alaska Medicaid can be found here.

ADULT COVERAGE
Yes. The state of Alaska offers two programs through which adults with autism can access ABA services:

  • Intensive Active Treatment (IAT): This service can be accessed through the Individual Developmental Disability (IDD) Waiver. This is application is through the Senior and Disability Services.
  • Complex Behavior Collaborative: Is a grant program intended for severe-risk individuals requiring intensive support to remain or return to their home community. This is a short-term service.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Alaska’s Medicaid clinical manual can be found here.
  • Alaska’s Medicaid billing manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Alaska’s EPSDT medical necessity definition can be found in Alaska Admin. Code 110.210.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Alaska can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

ALASKA DEPARTMENT OF INSURANCE 
The Alaska Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin B 15-05 was issued in 2015 to restate the requirements for coverage following the 2012 autism insurance reform bill.

Arizona

Click here to watch a short video detailing the individuals and efforts involved in Arizona’s autism insurance reform.

AUTISM INSURANCE REFORM
Arizona’s autism insurance bill, House Bill 2847, was enacted in 2008 and became effective on June 30, 2009.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Behavioral Therapy Services

DOES ARIZONA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage for behavioral therapy is limited to individuals with autism that are less than 17 years of age and is subject to annual dollar caps of $50,000 per year to those under the age of 9 and $25,000 per year to those between the ages of 9 and 16. The law does not apply to the following plans:

  • Individual Grandfathered Plans
  • Fully Insured Small Group Grandfathered Plans

LICENSURE
BCBA licensure was passed in Arizona in 2009 and revised in 2014 under House Bill 2173. The Arizona licensure board can be found here.

MEDICAID
Arizona’s Medicaid program – Arizona Health Care Cost Containment System (AHCCCS) - is Fee-For-Service. The fee schedule for ABA services considered by report, more information can be found here. Often, Individual health plans establish contracted rates between the MCO and ABA provider.

ADULT COVERAGE
Yes

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Arizona’s Medicaid policy manual for Behavior Analysis Services can be found here.
  • Arizona’s Medical Policy Manual for EPSDT (Chapter 430) can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Arizona’s EPSDT medical necessity definition can be found in the Arizona State Administrative Code Section 9.A.A.C. 22 on page 10, column 2, paragraph 3. A medical necessary definition can also be found in Arizona’s Medical Policy Manual for EPSDT (above) in the very first paragraph.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Arizona can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

ARIZONA DEPARTMENT OF INSURANCE 
The Arizona Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 2008-4 was issued in 2008 to reiterate the changes to Arizona law enacted via the autism insurance reform bill.

California

Click here to watch a short video detailing the individuals and efforts involved in California’s autism insurance reform.

AUTISM INSURANCE REFORM
California’s autism insurance bill, Senate Bill 946, was enacted in 2011 and became effective on July 1, 2012.

WHAT SERVICES ARE COVERED BY THE LAW?
Behavioral health treatment (e.g., Applied Behavior Analysis). For purposes of the law, “behavioral health treatment” is defined as “professional services and treatment programs, including ABA and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual.” Treatment must be prescribed by a licensed physician and provided by qualified autism serviceprovider, qualified autism service professional or qualified autism service paraprofessional.

DOES CALIFORNIA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.

LICENSURE
No.

MEDICAID
California’s Medicaid program, MediCal, is MCO. The fee schedule for ABA services under California Medicaid is not publicly available.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Click here for specific Medicaid information for each county in California.
    • A map of county regions for California can be found here.
  • For more information on All Plan Letters for the state of California, click here.
  • Additional information on California’s Medicaid can be found here.

EPSDT Medical Necessity Definition
California’s medical necessity definition can be found in California Welfare and Institutions Code, section 14059.5, subd.

STATE MENTAL HEALTH PARITY
California has an extensive and robust history with implementing and upholding mental health parity within the state. A detailed description and background of Mental Health Parity laws and regulations for the state of California can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E. SB 855)?
Yes. In August 2020 SB 855 was passed. More information about California’s general Standards of care can be found here. The law does not apply to the following plans:

  • Medi-Cal
  • Self-funded employer coverage
  • Other non-state regulated plans

CALIFORNIA DEPARTMENT OF INSURANCE
The California Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
The state of California’s Depart of Insurance issued a notice on March 30th 2020 to allow for services to be provided via telehealth during the COVID-19 emergency.

Colorado

Click here to watch a short video detailing the individuals and efforts involved in Colorado’s autism insurance reform.

AUTISM INSURANCE REFORM
Colorado’s autism insurance bill, Senate Bill 09-244, was enacted in 2009 and became effective on July 1, 2010. In 2015 autism coverage was amended to remove all age and dollar caps under Senate Bill 15-015, and became effective on January 1, 2017.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Behavior Training, Behavior Management, and Applied Behavior Analysis
  • Habilitative or rehabilitative care (e.g., Speech Therapy, Occupational Therapy, Physical Therapy)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care, including family counseling

DOES COLORADO HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. The law does not apply to the following plans:

  • Individual Grand-Fathered Plans

LICENSURE
No.

MEDICAID
Colorado’s Medicaid program, Health First Colorado, is fee-for-service. The fee schedule for ABA services under Colorado Medicaid can be found here.

ADULT COVERAGE OF ABA
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Colorado’s General Provider Information Manual can be found here.
  • Colorado’s EPSDT Program Manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Colorado’s EPSDT medical necessity definition can be found in the Colorado Code of Regulations 8.076.1.8on page 74 section 8.

STATE MENTAL HEALTH PARITY
Colorado’s most recent bill that included updates to the state’s mental health parity law, Senate Bill 21-266, was enacted in 2021. A detailed description and background of Mental Health Parity laws and regulations for the state of Colorado can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

COLORADO DEPARTMENT OF INSURANCE 
The Colorado Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin No. B-4.94 was issued in 2016 to address age discrimination and essential health benefits, as well as uphold the 2015 amendment.

Connecticut

Click here to watch a short video detailing the individuals and efforts involved in Connecticut’s autism insurance reform.

AUTISM INSURANCE REFORM
Connecticut’s autism insurance bill, Senate Bill 301, was enacted in 2009 and became effective on January 1, 2010. Bulletins HC-96 and HC-99 were published in 2014 and removed all dollar and age caps on ABA coverage.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Behavioral therapy, including Applied Behavior Analysis
  • Prescription Drugs
  • Psychiatric care and psychological care
  • Speech therapy, occupational therapy, physical therapy

DOES CONNECTICUT HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. The law does not apply to the following plans:

  • Individual Grandfathered Plans

LICENSURE
Licensure for BCBA’s was passed in Connecticut in 2017 under sHB 7167. The Connecticut licensure board can be found here.

MEDICAID
Connecticut’s Medicaid program, Connecticut Husky Health is Fee-For-Service. The fee schedule for ABA services under Connecticut Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Connecticut Medicaid’s provider manuals can be found here.
  • Connecticut’s Proposed Regulation for Requirements for Payment of Autism Spectrum Disorder Services can be found here. 

EPSDT MEDICAL NECESSITY DEFINITION
Colorado’s EPSDT medical necessity definition can be found in the Connecticut General Statutes Section 17b-259b.

STATE MENTAL HEALTH PARITY
Connecticut’s mental health parity law SB 301, was passed in 2009. A detailed description and background of Mental Health Parity laws and regulations for the state of Connecticut can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

CONNECTICUT DEPARTMENT OF INSURANCE 
The Connecticut Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Florida

Click here to watch a short video detailing the individuals and efforts involved in Florida’s autism insurance reform.

AUTISM INSURANCE REFORM
Florida’s autism insurance bill, Senate Bill 2654, was enacted in 2008 and became effective on April 1, 2009.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Screening and diagnosis
  • Applied Behavior Analysis
  • Speech, occupational, and physical therapy

DOES FLORIDA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Individuals must have been diagnosed with a developmental disability at 8 years of age or younger to be eligible. Coverage is extended to those older than 18 as long as they are in high school. Coverage for the treatment of autism is subject to a maximum annual benefit of $36,000 and a lifetime limit of $200,000. The law does not apply to the following plans:

  • Fully Insured Small Group Plans
  • Individual Plans

LICENSURE
No.

MEDICAID
Florida’s Medicaid program is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Florida Medicaid can be found here.

ADULT COVERAGE OF ABA
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Florida’s Coverage Policy for Behavior Analysis can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Florida’s EPSDT medical necessity definition can be found in The Florida Medicaid Definitions Manual on page 7, 2.83.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Florida can be found here.                                                     

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

FLORIDA DEPARTMENT OF INSURANCE 
The Florida Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Memorandum OIR-09-5M was issued in 2009 to notify changes of previous laws.

Georgia

LICENSURE
Licensure for BCBA’s was passed in Georgia in 2022 under HB 412 and will likely take effect in July 2023. 

Hawaii

Click here to watch a short video detailing the individuals and efforts involved in Hawaii’s autism insurance reform.

AUTISM INSURANCE REFORM
Hawaii’s autism insurance bill, Senate Bill 791, was enacted in 2015 and became effective on July 1, 2015.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Applied Behavior Analysis
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Speech, occupational, and physical therapy

DOES HAWAII HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals under the age of 14 years and coverage is capped at $25,000 per year. However, Hawaii complies with federal MHPAEA law and does not enforce these caps.

LICENSURE
Licensure for BCBA’s was passed in Hawaii in 2021 under Senate Bill 616. The Hawaii licensure board can be found here.

MEDICAID
Hawaii’s Medicaid program, QUEST, is administered through Managed Care Organizations (MCOs). The fee schedule for ABA services under Hawaii Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Hawaii’s Medicaid Manuals can be found here (Chapter 5 contains EPSDT information).
  • Hawaii Medical Service Association (HMSA; Hawaii’s version of a BCBS) is the only plan that puts out an ABA specific policy online. It can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Hawaii’s EPSDT medical necessity definition can be found in Hawaii Administrative Rules §17-1700.1-2 on page 42.

STATE MENTAL HEALTH PARITY
Hawaii’s mental health parity statute can be found in Hawaii Revised Statute §431M-2. A detailed description and background of Mental Health Parity laws and regulations for the state of Hawaii can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

HAWAII DEPARTMENT OF INSURANCE
The Hawaii Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Illinois

Click here to watch a short video detailing the individuals and efforts involved in Illinois’s autism insurance reform.

AUTISM INSURANCE REFORM
Illinois’ autism insurance bill, Public Law 095-1005, was enacted in 2008 and became effective on December 12, 2008.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Psychiatric Care
  • Psychological Care
  • Habilitative or rehabilitative care (Applied Behavior Analysis)
  • Therapeutic Care (Behavioral speech, occupational, and physical therapy)

DOES ILLINOIS HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism under the age of 21 years. Coverage for the diagnosis and treatment of autism is subject to a maximum annual benefit of approximately $50,000 for individual grandfathered plans. More information about Illinois’ Autism law can be found here.

LICENSURE
Licensure for BCBA’s was passed through HB4769 in May 2022 and will likely take effect in January 2024.

MEDICAID
Illinois’s Medicaid program, Application for Benefits Eligibility (ABE), is both fee-for-service and administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Illinois Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • The Handbook for Providers of Healthy Kids Services can be found here.
  • The most recent Provider Notice for ABA Services under Illinois Medicaid can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Illinois’s EPSDT Medical Necessity Definition can be found in Section 140.485 of the Healthy Kids Program paragraph d and Section 140.2 paragraph b.

STATE MENTAL HEALTH PARITY
Illinois’ mental health parity law can be found in the Illinois state statute 215 ILCS 5/370c. A detailed description and background of Mental Health Parity laws and regulations for the state of Illinois can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
Yes. In August 2021 HB2595 was passed. More information about Illinois’ general Standards of care can be found here.

ILLINOIS DEPARTMENT OF INSURANCE
The Illinois Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
The state Illinois Department of Insurance issued Bulletin 2020-04 on  March 25th, 2020 to allow for services to be provided via telehealth during the COVID-19 emergency.

Indiana

Click here to watch a short video detailing the individuals and efforts involved in Indiana’s autism insurance reform.

AUTISM INSURANCE REFORM
Indiana’s autism insurance bill, IC-27-8-14.2, was enacted in 2001 and became effective on July 1, 2001.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Treatment that is prescribed by the insured’s treating physician in accordance with a treatment plan

DOES INDIANA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.

LICENSURE
Licensure for BCBA’s was passed in Indiana in 2021 under House Bill 1516. The Indiana licensure board can be found here.

MEDICAID
Indiana’s Medicaid program is both fee-for-service and administered by MCE. The fee schedule for ABA services under Indiana Medicaid can be found here.

ADULT COVERAGE
No. However, while the State Plan continues to list an age limit of 20-years, on March 28th, 2022, in Conner Blessing v. Indiana Family and Social Services Administration (FSSA) the Court of Appeals of Indiana ruled that Medicaid is required to cover ABA for adults when medically necessary deeming that denying ABA coverage based solely upon age was discriminatory.

PROVIDER (CLINICAL AND BILLING) MANUALS
Indiana’s Medicaid clinical and billing manuals can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Indiana’s EPSDT Medical Necessity Definition can be found in the Indiana Admin. Code 405 5-2-17.

STATE MENTAL HEALTH PARITY
Indiana’s mental health parity law, SB 165, was enacted in 2016. A detailed description and background of Mental Health Parity laws and regulations for the state of Indiana can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

INDIANA DEPARTMENT OF INSURANCE
The Indiana Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 136 was issued in 2006 reiterating the requirement of health insurance coverage for treatment of Pervasive Developmental Disorders (PDDs; now “autism spectrum disorders (ASD)”). Bulletin 216 was issued in 2015 to require insurers to allow for treatment to continue during appeals processes.

Iowa

Click here to watch a short video detailing the individuals and efforts involved in Iowa’s autism insurance reform.

AUTISM INSURANCE REFORM
Iowa’s autism insurance bill, HF 215, was passed in 2017 and became effective on January 1, 2018.

WHAT SERVICES ARE COVERED BY THE LAW?
Applied Behavior Analysis

DOES IOWA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to those with autism under 19 years of age. ABA coverage is subject to a maximum annual benefit of $36,000 from ages 0 to 6 years, $25,000 for ages 7 to 13, and $12,500 for ages 14 to 18 (19th birthday there is no coverage mandated). The law does not apply to the following plans:

  • Individual Plans
  • Fully Insured Small Group Plans

LICENSURE
Licensure for BCBA’s was passed in Iowa in 2018 under Iowa SF 192. The Iowa licensure board can be found here.

MEDICAID
Iowa’s Medicaid program is administered through Managed Care Organizations (MCOs; current are Amerigroup and Iowa Total Care). The fee schedule for ABA services under Iowa Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Iowa’s Medicaid general program policies can be found here.
  • Iowa’s Medicaid general billing manual can be found here.
  • Individual provider manuals can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Iowa’s EPSDT Medical Necessity Definition can be found in the Iowa Rule 441-73.1(249A) on page 2.

STATE MENTAL HEALTH PARITY
Iowa’s mental health parity law can be found in sections 514C.22, 514C.27, and 514C.28 (autism section). A detailed description and background of Mental Health Parity laws and regulations for the state of Iowa can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

IOWA DEPARTMENT OF INSURANCE
The Iowa Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Kansas

 

LICENSURE
Licensure for BCBA’s was passed in Kansas in 2014 under The Applied Behavioral Analysis Act and was enacted in July 2016. The Kansas licensure board can be found here

Kentucky

Click here to watch a short video detailing the individuals and efforts involved in Kentucky’s autism insurance reform.

AUTISM INSURANCE REFORM
Kentucky’s autism insurance bill, House Bill 159, was enacted in 2010 and became effective on January 1, 2011. In 2018,  House Bill 218 amended this law to remove age and dollar caps on ABA coverage.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Habilitative or rehabilitative care (Applied Behavior Analysis)
  • Medical Care
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care (Speech, occupational, and physical therapy)

DOES KENTUCKY HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.

LICENSURE
Licensure for BCBA’s was passed in Kentucky in 2010 under House Bill 159. The Kentucky licensure board can be found here.

MEDICAID
Kentucky’s Medicaid program is managed-care-organization (MCO). The fee schedule for ABA services under Kentucky Medicaid can be found here.

ADULT COVERAGE
No. 

PROVIDER (CLINICAL AND BILLING) MANUALS
The Kentucky Medicaid Provider Billing Manual for Licensed Behavioral Analysts can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Kentucky’s EPSDT Medical Necessity Definition can be found in Kentucky Code 907 3:130.

STATE MENTAL HEALTH PARITY
Kentucky’s mental health parity law, HB 268, was enacted in 2000. A detailed description and background of Mental Health Parity laws and regulations for the state of Kentucky can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

KENTUCKY DEPARTMENT OF INSURANCE
The Kentucky Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Louisiana

Click here to watch a short video detailing the individuals and efforts involved in Louisiana’s autism insurance reform.

AUTISM INSURANCE REFORM
Louisiana’s autism insurance bill, Act 648, was enacted in 2008 and became effective on January 1, 2009. In 2012, Act 208 amended this law to raise the coverage age to 21 and eliminating life-time dollar caps and became effective on January 1, 2014.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Habilitative or rehabilitative care (Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care (Speech, occupational, and physical therapy)

DOES LOUISANA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism under the age of 21. Coverage for the treatment of autism is subject to a maximum annual benefit of $36,000. The law does not apply to the following plans:

  • Individual Grandfathered Plans

LICENSURE
Licensure for BCBA’s was passed in Louisiana in 2013 under Senate Bill 134 Act 351. The Louisiana licensure board can be found here.

MEDICAID
Louisiana’s Medicaid program is administered through Managed Care Organizations (MCOs). The fee schedule for ABA services under Louisiana Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
The Louisiana Provider Manual for Applied Behavior Analysis can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Louisiana’s EPSDT Medical Necessity Definition can be found in the Louisiana State Regulation 1101.

STATE MENTAL HEALTH PARITY
Louisiana has a number of laws of statues pertaining to parity. A detailed description and background of Mental Health Parity laws and regulations for the state of Louisiana can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

LOUISIANA DEPARTMENT OF INSURANCE
The Louisiana Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Maryland

Click here to watch a short video detailing the individuals and efforts involved in Maryland’s autism insurance reform.

AUTISM INSURANCE REFORM
Maryland’s autism insurance, HB 1055, was passed in May 2012, and became effective on November 1, 2013.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Behavioral health treatment, including applied behavior analysis. ABA may not be denied on the assertion that it is “experimental” or “investigational.”
  • Psychological care, including direct or consultative services and psychotherapy
  • Speech, occupational, and physical therapy

DOES MARYLAND HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. According to the Maryland Insurance Administration, the regulations do not establish caps or limits, but instead establish a floor for coverage, that carriers may not deny based solely on the number of hours of habilitative services prescribed, which differs depending on the age of the child, consistent with the Autism Technical Advisory Group’s report.

LICENSURE
Licensure for BCBA’s was passed in Maryland in 2017 under Bill 10.58.16. The Maryland licensure board can be found here.

MEDICAID
Maryland’s Medicaid program is fee-for-service for ABA services. The fee schedule for ABA services under Maryland Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
The Maryland Medical Assistance Program Applied Behavior Analysis (ABA) Provider Manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
The Maryland Medical Assistance Program Provider Manual’s definition for medical necessity can be found here on page 9.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Maryland can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

MARYLAND DEPARTMENT OF INSURANCE
The Maryland Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 14-07 was issued in 2014 regarding notification of new regulations to mandates.

Massachusetts

LICENSURE
Licensure for BCBA’s was passed in Massachusetts in 2017 under Senate Bill 135. The Massachusetts licensure board can be found here.

 

Michigan

Click here to watch a short video detailing the individuals and efforts involved in Michigan’s autism insurance reform.

AUTISM INSURANCE REFORM
Michigan’s autism insurance bills, Senate Bill 414, Senate Bill 415, and Senate Bill 981, were enacted in 2012 and became effective on October 15, 2012.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Behavioral Health Treatment (Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care and Psychological Care
  • Speech, occupational, and physical therapy

DOES MICHIGAN HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
On April 18, 2014, annual dollar limits in all fully insured plans were removed through No. 14-017-M.  Many private insurance companies in Michigan have removed age caps on autism services because of national parity laws and recent, state-level enforcement. Under Medicaid, Applied Behavior Analysis (ABA) services is provided for children under 21 years of age. 

LICENSURE
Licensure for BCBA’s was passed in Michigan in 2016 under Act 368; Senate Bill 1015 and Senate Bill 1016. The Michigan licensure board can be found here.

MEDICAID
Michigan’s Medicaid program is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Michigan Medicaid can be found here, in our library. 

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Michigan’s Medicaid Provider Manual can be found here. 

EPSDT MEDICAL NECESSITY DEFINITION
Michigan’s EPSDT medical necessity definition is pulled from the American Academy of Pediatrics (AAP) definition of medical necessity. The Michigan Provider Manual’s medical necessity definition can be found hereon page 676 (section 1, page 1 of the EDPST section of the manual).

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Michigan can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

MICHIGAN DEPARTMENT OF INSURANCE
The Michigan Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 2022-10-INS was issued in 2022 to remove age caps from private insurance plans.

Mississippi

LICENSURE
Licensure for BCBA’s was passed in Mississippi in 2015 under House Bill 885. The Mississippi licensure board can be found here.

 

Missouri

LICENSURE
Licensure for BCBA’s was passed in Missouri in 2010 under House Bills 1311 and 1341. The Missouri licensure board can be found here.

Montana

Click here to watch a short video detailing the individuals and efforts involved in Montana’s autism insurance reform.

AUTISM INSURANCE REFORM
Montana’s autism insurance bill, Senate Bill 234, was enacted in 2009 and became effective on January 1, 2010.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Habilitative or rehabilitative (Applied Behavior Analysis)
  • Medications
  • Psychiatric or psychological care
  • Therapeutic care (Speech, occupational, and physical therapy)

DOES MONTANA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No.

LICENSURE
Licensure for BCBA’s was passed in Montana in 2017 under Senate Bill 193. The Montana licensure board can be found here.

MEDICAID
Montana’s Medicaid program is fee-for service. The fee schedule for ABA services under Montana Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Montana’s Medicaid Applied Behavior Analysis Services Manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Montana’s medically necessity definition can be found in Montana Rule ARM 37.82.102 (18).

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Montana can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No. 

MONTANA DEPARTMENT OF INSURANCE
The Montana Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Nevada

Click here to watch a short video detailing the individuals and efforts involved in Nevada’s autism insurance reform.

AUTISM INSURANCE REFORM
Nevada’s autism insurance bill, Assembly Bill 162, was enacted in 2009 and became effective on January 1, 2011.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Screening and Diagnosis
  • Habilitative or rehabilitative (including applied behavior analysis)
  • Prescription Care
  • Psychiatric and Psychological Care
  • Speech, Occupational, and Physical Therapy

DOES NEVADA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. The law limits coverage to individuals with autism under the age of 18 (or until age 22 if still enrolled in high school). Coverage for ABA is subject to a maximum annual benefit of $36,000. The law does not apply to the following plans:

  • Individual Grandfathered Plans

LICENSURE
Licensure for BCBA’s was passed in Nevada in 2018. The Nevada licensure board can be found here.

MEDICAID
Nevada’s Medicaid program is both fee-for-service and administered by Managed Care Organizations (MCOs). Instructions for how to access the fee schedule for ABA services under Nevada Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Nevada’s Medicaid billing manual for Applied Behavior Analysis can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
The Nevada Medicaid Services Manual’s medical necessity definition can be found here on page 34.

STATE MENTAL HEALTH PARITY
In 2009, Nevada passed SB426 to align the state with federal MHPAEA laws. In 2014 AB425 was passed to further bring Nevada into compliance. A detailed description and background of Mental Health Parity laws and regulations for the state of Nevada can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

NEVADA DEPARTMENT OF INSURANCE
The Nevada Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DEPARTMENT OF INSURANCE BULLETINS
None.

 

New Jersey

LICENSURE
Licensure for BCBA’s was passed in New Jersey in 2020. The New Jersey licensure board can be found here.

New Mexico

Click here to watch a short video detailing the individuals and efforts involved in New Mexico’s autism insurance reform.

AUTISM INSURANCE REFORM
New Mexico’s autism insurance bill, Senate Bill 39, was enacted in 2009 and became effective on January 1, 2010. In 2013, House Bill 22 added coverage for state employees and became effective on January 1, 2015. In 2019,  House Bill 322 removed all age and dollar caps from the law and became effective on June 15, 2019.

WHAT SERVICES ARE COVERED BY LAW?

  • Screening and Diagnosis
  • Applied Behavior Analysis
  • Speech, Occupational, and Physical Therapy

DOES NEW MEXICO HAVE ANY CAPS ON ABA COVERAGE?
No.

LICENSURE
No. 

MEDICAID
New Mexico’s Medicaid program is administered by Managed Care Organizations (MCOs; Blue Cross Blue Shield, Presbyterian, and Western Sky). The fee schedule for ABA services under New Mexico Medicaid can be found here.

ADULT COVERAGE
Yes. In 2019,  House Bill 322 removed all age and dollar caps from the law and became effective on June 15, 2019.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • The New Mexico Medicaid Behavioral Health Policy and Billing Manual can be found here.
  • New Mexico’s ABA guideline supplement can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
New Mexico’s medical necessity definition can be found in New Mexico Code 8.302.1.7.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of New Mexico can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No. 

NEW MEXICO DEPARTMENT OF INSURANCE
The New Mexico Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin No. 2015-013 was issued in March 2015 expanding coverage to small group and individual insurance plans.

New York

LICENSURE
Licensure for BCBA’s was passed in New York in 2022 under Senate Bill 1662. The New York licensure board can be found here.

North Carolina

Click here to watch a short video detailing the individuals and efforts involved in North Carolina’s autism insurance reform.

AUTISM INSURANCE REFORM
North Carolina’s autism insurance bill, Senate Bill 676, was enacted on October 15, 2015, and became effective on July 1, 2016.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Adaptive Behavior Treatment
  • Psychiatric Care
  • Psychological Care
  • Speech, Occupational, and Physical Therapy
  • Pharmacy Care

DOES NORTH CAROLINA HAVE CAPS ON ABA COVERAGE?
Yes. Coverage for adaptive behavior treatment is limited to individuals under 19 years of age and is capped at $40,000 per year. The law does not apply to the following plans:

  • Individual Non-Grandfathered Plans
  • Fully Insured Small Group Non-Grandfathered Plans

LICENSURE
Licensure for BCBA’s was passed in North Carolina in 2021 under Senate Bill 103.  The North Carolina licensure board can be found here.

MEDICAID
North Carolina’s Medicaid program is administered by Managed Care Organizations (MCO). The fee schedule for ABA services under North Carolina Medicaid can be found here and here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
The North Carolina Medicaid Research-Based Behavioral Health Treatment for Autism Spectrum Disorder Manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
The North Carolina EPSDT policies’ definition for medical necessity can be found here (page 1 paragraph 2).

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of North Carolina can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

NORTH CAROLINA DEPARTMENT OF INSURANCE
The North Carolina Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

North Dakota

LICENSURE
Licensure for BCBA’s was passed in North Dakota in 2020 under Senate Bill 2236. The North Dakota licensure board can be found here.

Ohio

Click here to watch a short video detailing the individuals and efforts involved in Ohio’s autism insurance reform.

AUTISM INSURANCE REFORM
Ohio’s autism insurance bill, House Bill 463 (Sec. 1751.84), was enacted in 2017. 

WHAT SERVICES ARE COVERED BY THE LAW?

  • Speech therapy
  • Occupational therapy
  • Clinical Therapeutic Intervention, including applied behavior analysis
  • Mental/behavioral health outpatient services

DOES OHIO HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under 21 years. Benefits are subject to maximum annual or weekly limits.

  • Speech therapy is subject to a maximum annual limit of 20 visits
  • Occupational therapy is subject to a maximum annual limit of 20 visits
  • ABA is subject to a maximum weekly limit of 20 hours
  • Mental/behavioral health outpatient services are subject to a maximum annual limit of 30 visits

LICENSURE
No. However, Ohio does have a certification for BCBA’s under the Ohio Psychology Licensing Board – Certified Ohio Behavior Analyst (COBA). The COBA certification for BCBA’s was passed in Ohio in 2014 under HB 59. The Ohio licensure board can be found here.

MEDICAID
Ohio offers most Medicaid services through managed care organizations (MCO) with some of the population till on fee-for-service (FFS) Medicaid. The suggested fee schedule for ABA services under Ohio Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Ohio’s ABA Provider manual will be released this fall (2022).

EPSDT MEDICAL NECESSITY DEFINITION
Ohio’s EPSDT Medical Necessity Definition can be found in Ohio State Code 5160-1-01.

STATE MENTAL HEALTH PARITY
Ohio’s mental health parity law, Senate Bill 284, was enacted in 2021.  A detailed description and background of Mental Health Parity laws and regulations for the state of Ohio can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

OHIO DEPARTMENT OF INSURANCE
The Ohio Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 2018-05 was issued in 2018 regarding obligations for short-term, limited-duration policies.

Oklahoma

Click here to watch a short video detailing the individuals and efforts involved in Oklahoma’s autism insurance reform.

AUTISM INSURANCE REFORM
Oklahoma’s autism insurance bill, House Bill 2962, was enacted in 2016 and became effective on November 1, 2016. In August 2021, LH Bulletin No. 2021-03 was issued to removed dollar, age, and dollar caps.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Screening, Diagnosis, and Treatment of Autism Spectrum Disorder
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care
  • Behavioral Health Treatment
  • Applied Behavior Analysis

DOES OKLAHOMA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
The law does not apply to the following plans:

  • Individual Non-Grandfathered Plans
  • Fully Insured Small Group Non-Grandfathered Plans

LICENSURE
Licensure for BCBA’s was passed in Oklahoma in 2009 under SB 135. The Oklahoma licensure board can be found here.

MEDICAID
Oklahoma’s Medicaid program, SoonerCare, is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Oklahoma Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
A general Provider Billing and Procedures Manual for Oklahoma can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Oklahoma’s medical necessity definition can be found in Oklahoma Rule 317:30-3-1 paragraph f.

STATE MENTAL HEALTH PARITY
In 2020 Oklahoma passed SB 1718  which brough Oklahoma into compliance with the federal MHPAEA law. A detailed description and background of Mental Health Parity laws and regulations for the state of Oklahoma can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

OKLAHOMA DEPARTMENT OF INSURANCE
The Oklahoma Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 2021-03 was issued in 2021 regarding removing age caps and other federal MHPAEA violations.

Oregon

LICENSURE
Licensure for BCBA’s was passed in Oregon in 2021 under Senate Bill 358. The Oregon licensure board can be found here.

Pennsylvania

Click here to watch a short video detailing the individuals and efforts involved in Pennsylvania’s autism insurance reform.

AUTISM INSURANCE REFORM
Pennsylvania’s autism insurance bill, House Bill 1150, was enacted in 2008 and became effective on July 1, 2009.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Habilitative or rehabilitative care (Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Therapeutic Care (Speech therapy, occupational therapy, and physical therapy)

DOES PENNSYLVANIA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage for the treatment of autism is limited to individuals under 21 years of age and is subject to a maximum benefit of $36,000. The law does not apply to the following plans:

  • Individual Plans
  • Fully Insured Small Group Plans

LICENSURE
No.

MEDICAID
Pennsylvania’s Medicaid program, Medical Assistance (MA), is administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under Pennsylvania Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Billing and clinical guidelines for Pennsylvania Medicaid can be found here.

EPSDT Medical Necessity Definition
Pennsylvania’s medical necessity definition can be found in Pennsylvania Code 1101.21a.

STATE MENTAL HEALTH PARITY
In 2010 Pennsylvania passed SB237 requiring insurers to comply with the federal MHPAEA law. A detailed description and background of Mental Health Parity laws and regulations for the state of Pennsylvania can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

PENNSYLVANIA DEPARTMENT OF INSURANCE
The Pennsylvania Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin 2022-04 was issued in 2022 regarding the increase in maximum benefit for autism spectrum disorders.

Rhode Island

Click here to watch a short video detailing the individuals and efforts involved in Rhode Island’s autism insurance reform.

AUTISM INSURANCE REFORM
Rhode Island’s autism insurance bills, H 5275 Sub A (2011) and H 7165 Sub A (2012), were enacted in 2011 and became effective on January 1, 2012.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Pharmaceuticals
  • Applied Behavior Analysis
  • Physical therapy and Speech therapy
  • Psychology, psychiatric, and occupational therapy services

DOES RHODE ISLAND HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under the age of 15 years. Coverage for Applied Behavior Analysis is subject to a maximum benefit of $32,000 per year. The law does not apply to the following plans:

  • Individual Plans
  • Fully Insured Small Group

LICENSURE
Licensure for BCBA’s was passed in Rhode Island in 2012 under S 2559.  The Rhode Island licensure board can be found here.

MEDICAID
Rhode Island’s Medicaid program is fee-for-service. The fee schedule for ABA services under Rhode Island Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • Rhode Island Medicaid’s General Guidelines Provider Reference Manual can be found here.
  • The link to Rhode Island’s list of Early Intervention Standards for Medicaid can be found here.
  • Rhode Island Medicaid Early Intervention Policies and Procedures for System of Payments can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
The Rhode Island Provider Manual’s medical necessity definition can be found here (page 10).

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Rhode Island can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

RHODE ISLAND DEPARTMENT OF INSURANCE
The Rhode Island Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

South Carolina

Click here to watch a short video detailing the individuals and efforts involved in South Carolina’s autism insurance reform.

AUTISM INSURANCE REFORM
South Carolina’s autism insurance bill, S20, was enacted in 2007 and became effective on July 8, 2008.

WHAT SERVICES ARE COVERED BY THE LAW?
Coverage is limited to treatment that is prescribed by the insured’s treating medical doctor in accordance with a treatment plan

DOES SOUTH CAROLINA HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under the age of 16 years, and the individual must have been diagnosed with autism spectrum disorder by age eight or younger. Coverage for ABA is subject to a maximum benefit of $50,000 per year. The law does not apply to the following plans:

  • Individual Grandfathered Plans
  • Individual Non-Grandfathered Plans
  • Fully Insured Small Group Grandfathered Plans
  • Fully Insured Small Group Non-Grandfathered Plans

LICENSURE
No.

MEDICAID
South Carolina’s Medicaid program, Healthy Connections, is both fee-for-service and administered by Managed Care Organizations (MCOs). The fee schedule for ABA services under South Carolina Medicaid can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • South Carolina Medicaid’s Autism Spectrum Disorder Services Provider Manual can be found here.
  • South Carolina Medicaid’s Provider Administrative and Billing Manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
South Carolina’s EPSDT medical necessity definition can be found here.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of South Carolina can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No. 

SOUTH CAROLINA DEPARTMENT OF INSURANCE
The South Carolina Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
Bulletin No. 2021-07 was issued in 2021 to increase the maximum benefit for autism spectrum disorders.

South Dakota

LICENSURE
Licensure for BCBA’s was passed in South Dakota in 2016 under Chapter 36-38; Rule 20-85. The South Dakota licensure board can be found here.

Tennessee

LICENSURE
Licensure for BCBA’s was passed in Tennessee in 2013 under House Bill 1279. The Tennessee licensure board can be found here.

Texas

Texas requires meaningful coverage for autism under state-regulated plans.
Texas's autism insurance bill, SB 946, was enacted in 2011 and became effective on July 1, 2012.

TO WHICH PLAN DOES THE STATE AUTISM INSURANCE LAW APPLY?

Individual Plans - YES
Fully Insured Large Group Plans - YES
Fully Insured Small Group - YES

WHAT SERVICES ARE COVERED BY LAW?

Behavioral health treatment (e.g. Applied Behavior Analysis) - for purposes of the law, “behavioral health treatment” is defined as “professional services and treatment programs, including ABA and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual.” Treatment must be prescribed by a licensed physician and provided by qualified autism service provider, qualified autism service professional or qualified autism service paraprofessional.

DOES TEXAS HAVE CAPS ON ABA COVERAGE?

Yes. As of September 1st, 2013, there is no age limit on coverage for the treatment of autism. However, in order to be eligible for coverage, the individual must have been diagnosed with autism prior to age 10.

WHERE CAN I FIND MORE DETAILS ABOUT THE TEXAS AUTISM INSURANCE LAW?

A copy of SB 946 as enrolled can be found here.

LICENSURE
Licensure for BCBA’s was passed in Texas in 2017 under Senate Bill 589. The Texas licensure board can be found here.

Utah

Click here to watch a short video detailing the individuals and efforts involved in Utah’s autism insurance reform.

AUTISM INSURANCE REFORM
Utah’s autism insurance bill, Senate Bill 57, was enacted in 2014 and became effective on January 1, 2016. In 2019, Senate Bill 95 was passed and removed age and dollar caps from coverage.

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Applied behavior analysis and other behavioral health treatments
  • Speech therapy, occupational therapy, and physical therapy

DOES UTAH HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
No. The law does not apply to the following plans:

  • Fully Insured Small Group Plans

LICENSURE
Licensure for BCBA’s was passed in Utah in 2015 under SB 246. The Utah licensure board can be found here.

MEDICAID
Utah’s Medicaid program is fee-for-service. The fee schedule for ABA services under Utah Medicaid is not publicly available.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS
Utah’s Medicaid Provider Manual for autism can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
The Utah Medicaid Provider Manual contains a medical necessity definition on page 39.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Utah can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

UTAH DEPARTMENT OF INSURANCE
The Utah Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
No.

Vermont

Click here to watch a short video detailing the individuals and efforts involved in Vermont’s autism insurance reform.

AUTISM INSURANCE REFORM
Vermont’s autism insurance bill, S. 262, was enacted in 2010 and became effective on July 1, 2011 In 2012, S. 223 amended this bill by raising the age cap and requiring the same benefits be provided by the state Medicaid program or any other public health care assistance program. 

WHAT SERVICES ARE COVERED BY THE LAW?

  • Diagnosis
  • Behavioral health treatment (Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care (services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists, or social workers)

DOES VERMONT HAVE ANY CAPS OR RESTRICTIONS ON ABA COVERAGE?
Yes. Coverage is limited to individuals with autism under age 21.

LICENSURE
Licensure for BCBA’s was passed in Vermont in 2015 under S.136. The Vermont licensure board can be found here.

MEDICAID
The fee schedule for ABA services under Vermont Medicaid can be found here. An explanation of Vermont’s payment model can be found here.

ADULT COVERAGE
No.

PROVIDER (CLINICAL AND BILLING) MANUALS

  • The Vermont Medicaid Applied Behavior Analysis Supplement can be found here.
  • The Department of Vermont Health Access ABA Clinical Practice Guidelines can be found here.
  • Vermont’s General Billing and Forms Manual can be found here.

EPSDT MEDICAL NECESSITY DEFINITION
Vermont’s medical necessity definition can be found in Vermont Health Care Administrative Rules.

STATE MENTAL HEALTH PARITY
A detailed description and background of Mental Health Parity laws and regulations for the state of Vermont can be found here.

DOES IT INCLUDE GENERAL STANDARDS OF CARE? (I.E., SB 855)
No.

VERMONT DEPARTMENT OF INSURANCE
The Vermont Department of Insurance website can be found here. You can submit a complaint to your state DOI here

DOI BULLETINS
None.

Virginia

LICENSURE
Licensure for BCBA’s was passed in Virginia in 2012 under House Bill 1106. The Virginia licensure board can be found here.

Washington

LICENSURE
Licensure for BCBA’s was passed in Washington in 2015 under Substitute SB 5488. The Washington licensure board can be found here.

Wisconsin

LICENSURE
Licensure for BCBA’s was passed in Wisconsin in 2009 under Senate Bill 667. The Wisconsin licensure board can be found here.

Wyoming

LICENSURE
Licensure for BCBA’s was passed in Wyoming in 2022. The Wyoming licensure board can be found here.

To the best of our ability, the information above is accurate and up to date, but it is up to the consumer to investigate fully before making any decisions regarding health care coverage.

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