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

o        PDD-NOS

–          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?

–          Assessments

–          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 vapnova@gmail.com for details.

–          Visit http://www.autismvotes.org/

Melissa Ruiz, BCaBA

BASICS ABA Therapy, LLC

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