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 Kansas has a specific autism mandate, which requires certain insurers to provide coverage for autism spectrum disorder.
Effective January 1, 2011, the mandate requires the state employees' health care commission to provide for the coverage of services for the diagnosis and treatment of autism spectrum disorder in any covered individual whose age is less than 19 years. Coverage is determined in consultation with the autism services provider and the patient. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is between birth and less than seven years shall not exceed $36,000 per year. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is at least seven years and less than 19 years shall not exceed $27,000 per year.
Effective January 1, 2015, the mandate requires any large group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization which provides coverage for accident and health services and which is delivered, issued for delivery, amended or renewed to provide coverage for the diagnosis and treatment of autism spectrum disorder in any covered individual whose age is less than 12 years.
Note: Speech language services are not clearly defined in the statue. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.
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.