What does it do?

It requires health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder, which currently affects 1 in every 110 individuals. The text of the law can be found at http://www.mass.gov/legis/laws/seslaw10/sl100207.htm

When does it go into effect?

It went into effect January 1, 2011, but implementation will be based on each policy’s specific renewal date. If you have insurance under a policy that is subject to (see below), the coverage must be provided when the policy renews on or after January 1, 2011, meaning it will go into effect the date that your company’s insurance plan renews annually.

What types of policies through ARICA cover ABA?

The legislation affects only certain types of health care policies, so coverage under ARICA depends on the type of policy you have. Private insurers, employees and retirees under the state plan, hospital service plans and HMOs are all required to comply with the mandate. Many employers have ‘self-funded’ plans, which are regulated under a federal law and not subject to ARICA. However, a majority of ‘self-funded’ plans in Massachusetts are covering autism treatments.

How can I find out if I have coverage under the new mandates?

Contact your employer to verify that your policy is subject to the new law, and if so, what annual date your group policy renews. Even if your company is regulated by, they may, as practice, comply with State laws. In addition, there is language in the recently enacted federal health care reform that will eventually cover autism treatment. If you are covered by a plan, please contact us for additional information and assistance in advocating for coverage with your company.

Are individuals or family members covered for services under Mass Health or Common Health?

These programs are not subject to the new law, but consumers should know the following:

  • Mass Health may cover co-pays and deductibles for some mandated treatments covered by private insurance.
  • The Premium Assistance Program can help subsidize the purchase of private insurance policies and policies through Commonwealth Choice that will cover.
  • Families covered by Mass Health with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through. Note – this is a limited program with specific application windows.

Is there a limit to the amount of the coverage?

No. The diagnosis and treatment of Autism Spectrum Disorders will not be subject to any annual or lifetime dollar or unit of service limitation on coverage which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.

Is there an age limit to this coverage?

There is no age limit.

How are education services affected?

Educational services are not affected and Insurers are not required to pay for in-school services. Conversely, schools may not require parents to access private insurance for services that are part of the IEP.