Autism Insurance Reform Takes Effect in NC July 2016

22289847_mLast year, North Carolina became the 43rd state to finally pass Autism Insurance legislation. For the past several years, Lorri Unumb and others with Autism Speaks have led families and advocates for families of people with autism spectrum disorders in a hard-fought battle for insurance coverage of ABA therapy. Last year, state congressional leaders passed Senate Bill 676. The bill will require certain health plans to cover autism diagnosis and proven effective treatment, including ABA therapy.

In addition, in 2015 North Carolina became the 30th state to pass the ABLE Act. The ABLE Act allows families to save money for disability-related expenses in a tax-exempt 529A savings account.

How will the mandate help my child?
The new mandate takes effect July 1, 2016. The plans covered by this bill are large group health plans (employers with 50 or more employees) , “grandfathered” plans which are individual or small group plans that have been in effect and essentially unchanged since March 2010, and “grandmothered” plans which are individual / small group plans that do not qualify as grandfathered plans but were in effect prior to 2014.

Coverage under the mandate must include screening, diagnosis, and treatment of Autism Spectrum Disorders. Treatment coverage includes therapeutic care (OT, PT, Speech), psychiatric care, psychological care, pharmacy care, and Adaptive Behavior Treatment which includes ABA therapy.

ABA (Applied Behavior Analysis) Therapy coverage is subject to age and dollar cap limitations. ABA therapy can be limited to those ages 18 and under, and may be limited to $40,000 per year.

What should I do if my child needs ABA Therapy?
If you are interested in receiving ABA therapy services for your child, would like to learn more about ABA or the mandate, please contact us with any questions.  Whether calling our company or other providers, don’t wait for the new coverage to begin to call for services – we do expect wait lists to develop and/or increase as more children obtain insurance coverage and seek services.  Priorities ABA is working hard to expand our ability to help more children. The passage of the autism insurance mandate will allow us to expand our services helping children in the Raleigh and Charlotte areas.

What other insurance covers ABA? What if my insurance isn’t covered by the mandate or I’m not sure if I have coverage?
Currently, Tricare and the North Carolina State Employee health insurance plan cover ABA therapy for children on the Autism Spectrum. In addition, some self-funded large employers’ plans (ERISA plans) have opted to add coverage of ABA therapy.  If you are unsure about your coverage, call your insurance provider and ask about the details of your plan.

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