Vote Smart's Synopsis:

Vote to concur with House amendments and pass a bill that requires insurance providers to cover the diagnosis and treatment of autism.

Highlights:

• Requires insurance providers to cover the diagnosis and treatment of autism spectrum disorders.

• Defines “autism spectrum disorders” to include the following:
• Autistic disorder;
• Asperger’s disorder; or
• A "pervasive developmental disorder not otherwise specified".

• Prohibits insurance providers from doing any of the following:
• Limiting the number of visits a member may use for the treatment of an autism spectrum disorder;
• Denying or limiting coverage on the basis that treatment is educational or habilitative in nature; or
• Subjecting coverage to dollar limits, copays, deductibles, or coinsurance provisions that do not generally apply to physical illnesses.

• Specifies that coverage for the treatment of autism is required through 18 years of age with a maximum annual benefit of:
• $50, 000 for a covered member under 6 years of age;
• $40, 000 for a covered member with an age of 7-12 years; and
• $30,000 for a covered member with an age of 13-18 years.

• Specifies that beginning January 1, 2014, the coverage requirements outlined in this law are not necessary for a qualified health plan that exceeds coverage included in the “essential health benefits” required under the Federal Patient Protection and Affordable Care Act.

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that requires insurance providers to cover the diagnosis and treatment of autism.

Highlights:

• Requires insurance providers to cover the diagnosis and treatment of autism spectrum disorders.

• Defines “autism spectrum disorders” to include the following:
• Autistic disorder;
• Asperger’s disorder; or
• A "pervasive developmental disorder not otherwise specified".

• Prohibits insurance providers from doing any of the following:
• Limiting the number of visits a member may use for the treatment of an autism spectrum disorder;
• Denying or limiting coverage on the basis that treatment is educational or habilitative in nature; or
• Subjecting coverage to dollar limits, copays, deductibles, or coinsurance provisions that do not generally apply to physical illnesses.

• Specifies that coverage for the treatment of autism is required through 18 years of age with a maximum annual benefit of:
• $50, 000 for a covered member under 6 years of age;
• $40, 000 for a covered member with an age of 7-12 years; and
• $30,000 for a covered member with an age of 13-18 years.

• Specifies that beginning January 1, 2014, the coverage requirements outlined in this law are not necessary for a qualified health plan that exceeds coverage included in the “essential health benefits” required under the Federal Patient Protection and Affordable Care Act.

Full Bill Text