Virginia 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 Virginia has a specific autism mandate.

The mandate requires health insurance plans to provide coverage for the diagnosis and the treatment of autism spectrum disorder. Plans issued or renewed from January 1, 2012, to January 1, 2016, for individuals from age two through age six; from January 1, 2016, until January 1, 2020, from age two years through age 10 years; and from and after January 1, 2020, of any age. An individual who is being treated and continues to need treatment for autism spectrum disorder and becomes seven years of age or older is not precluded from coverage of treatment and services. Treatment shall be determined by a licensed physician or a licensed psychologist to be medically necessary, and includes: (i) behavioral health treatment, (ii) pharmacy care, (iii) psychiatric care, (iv) psychological care, (v) therapeutic care (which includes services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers), and (vi) applied behavior analysis when provided or supervised by a board certified behavior analyst who shall be licensed by the Board of Medicine. Certain insurers may be exempt from requirements for 1 year and may reapply for the exemption yearly.

Resources

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

Va. Code Ann. § 38.2-3418.17

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

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