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Pennsylvania Insurance Requirements for Autism Spectrum Disorder

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.

Specific Insurance Mandate

The state of Pennsylvania has a specific autism mandate.

The mandate requires a health insurance policy or government program to provide coverage for individuals less than 21 years of age for the diagnostic assessment and treatment of autism spectrum disorder. Treatment includes: pharmacy care, psychiatric care, psychological care, rehabilitative care and therapeutic care (includes services provided by speech language pathologists, occupational therapists or physical therapists) that is medically necessary and prescribed, ordered or provided by a licensed physician, licensed physician assistant, licensed psychologist, licensed clinical social worker or certified registered nurse practitioner. Coverage provided under this section by an insurer shall be subject to a maximum benefit of $37,080 per year and is not subject to any limits on the number of visits to an autism service provider for treatment of autism spectrum disorders.

Resources

For further information on insurance mandates for autism spectrum disorder, please visit this website:

Pa. Cons. Stat. tit. 40 §764h

Questions regarding state affairs issues? Call ASHA at 800-498-2071 and ask for the State Affairs Team.

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