Wisconsin Insurance Requirements for Autism
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 Wisconsin has a specific autism mandate.
The mandate requires every disability insurance policy, and every self−insured health plan of the state or a county, city, town, village, or school district, to provide coverage for an insured of treatment for the mental health condition of autism spectrum disorder if the treatment is prescribed by
a physician and provided by any of the following who are qualified to provide intensive−level services or nonintensive−level services: a psychiatrist; a psychologist; a social worker; a paraprofessional working under the supervision of a psychiatrist, psychologist or social worker; a professional working under
the supervision of an outpatient mental health clinic; a speech−language pathologist; or an occupational therapist. The coverage required shall provide at least $50,000 for intensive−level services per insured per year, with a minimum of 30 to 35 hours of care per week for a minimum duration of 4 years,
and at least $25,000 for nonintensive−level services per insured per year.
For further information on insurance mandates for autism spectrum disorder, please visit this website:
Wis. Stat. §632.895(12m)
Questions regarding state affairs
issues? Call ASHA at 800-498-2071 and ask for the State Affairs Team.