The information below is collected from state statutes and regulations. The information is reviewed on an annual basis. Please be advised that laws, regulations, and policies may change at any time, so always check with your state for the most up-to-date information.
Note: Certain insurance plans are exempt from state mandates. Please contact your plan administrator to see if your plan includes state mandated autism spectrum disorder benefits.
The state of Kentucky has a specific autism mandate, which requires that a large group health benefit, individual, and small group market health benefit plans provide coverage for the diagnosis and treatment of autism spectrum disorders.
Treatment includes: medical care; habilitative or rehabilitative care; pharmacy care, if covered by the plan; psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); and applied behavior analysis prescribed or ordered by a licensed health or allied health professional. Coverage under this section shall be subject to a maximum annual benefit per covered individual as follows: for individuals between the ages of one (1) through their seventh birthday, the maximum annual benefit shall be $50,000 per individual; for individuals between the ages of seven (7) through 21, the maximum benefit shall be $1,000, per month per individual.
All health benefit plans in the individual and small group market shall provide coverage for pharmacy care, if covered by the plan: psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); applied behavior analysis; habilitative and rehabilitative care. Coverage for autism spectrum disorders shall be subject to $1,000 maximum benefit per month, per covered individual.
For further information on insurance mandates for autism spectrum disorder, please visit these websites:
Questions regarding state affairs issues? Call ASHA at 800-498-2071 and ask for the State Affairs Team.