(a) After the effective date of this subchapter, a health care insurer that offers, issues for delivery, delivers, executes, adjusts, uses, or renews a health care insurance plan shall provide coverage for the costs of the diagnosis and treatment of autism spectrum disorders that are medically necessary and evidence-based.
(b) Coverage required in health care insurance plans by this section must include treatment prescribed, identified and ordered by a licensed physician, psychologist, or a licensed clinical social worker for an insured who is diagnosed with an autism spectrum disorder in accordance with a treatment plan developed by licensed physician, licensed psychologist or licensed clinical social worker pursuant to a comprehensive evaluation or re-evaluation of the insured.
(c) Covered treatment must include:(1) Behavioral therapy, including applied behavioural analysis in the school, home, community, and office settings;(2) Direct psychiatric or consultative services provided by a licensed psychiatrist;(3) Direct psychological or consultative services provided by a licensed psychologist;(4) Physical therapy provided by a licensed physical therapist in the school, home, community, and office;(5) Speech and language pathology services provided by a licensed speech and language pathologist;(6) Occupational therapy provided by a licensed occupational therapist in the school, home, community, and office;(7) Prescription drugs, to the extent prescription drugs are a covered benefit for other diseases and conditions under such policy, prescribed by a licensed physician, licensed physician assistant or advanced practice registered nurse for the treatment of symptoms and comorbidities of autism spectrum disorders; and(8) Equipment determined necessary to provide evidence-based treatment.
(1) Behavioral therapy, including applied behavioural analysis in the school, home, community, and office settings;
(2) Direct psychiatric or consultative services provided by a licensed psychiatrist;
(3) Direct psychological or consultative services provided by a licensed psychologist;
(4) Physical therapy provided by a licensed physical therapist in the school, home, community, and office;
(5) Speech and language pathology services provided by a licensed speech and language pathologist;
(6) Occupational therapy provided by a licensed occupational therapist in the school, home, community, and office;
(7) Prescription drugs, to the extent prescription drugs are a covered benefit for other diseases and conditions under such policy, prescribed by a licensed physician, licensed physician assistant or advanced practice registered nurse for the treatment of symptoms and comorbidities of autism spectrum disorders; and
(8) Equipment determined necessary to provide evidence-based treatment.