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West 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 West Virginia has a specific autism mandate.

The mandate requires health insurance plans issued or renewed after January 1, 2012, to include coverage for diagnosis, evaluation and treatment of autism spectrum disorder in individuals aged eighteen months to eighteen years. The individual must be diagnosed with autism spectrum disorder at age 8 or younger. Treatment shall be determined to be medically necessary by a licensed physician or licensed psychologist.

Note: Speech language services are not clearly defined in the statue. However, applied behavioral analysis is specifically included and coverage limitations are set out. 

Resources

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

W.Va. Code § 5-16B-6e, 33-16-3v, 33-24-7k, 33-25A-8j (as created by HB 2693 [2011])

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

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