The Affordable Care Act (ACA) and Autism

National Autism Network – Synopsis of Law: 

· Federal Health Care Reform and Autism Insurance

  • Prohibits discrimination in benefits against people with autism by including behavioral health treatments as part of the essential benefits package
  • Provides grants for mental and behavioral health education and training
  • Beginning 2014, health plans will include essential benefits package. The following is a list of items and services deemed essential:

-Ambulatory patient services
-Emergency services
-Hospitalization
-Maternity and newborn care
-Mental health and substance use disorder services, including behavioral health treatment
-Prescription drugs
-Rehabilitative and habilitative services and devices
-Laboratory services
-Preventive and wellness services and chronic disease management
-Pediatric services, including oral and vision care

  • Requires the following health plans to cover the list of essential benefits, including behavioral health treatment beginning in 2014:

-Plans offered by state-based exchanges, through which individuals and small businesses can purchase coverage

-Plans offered in the individual and small group markets outside the health insurance exchange

  • Does NOT require the following health insurance plans to provide essentials benefits package:

-Existing coverage
-Plans offered in the large group market outside exchanges
-Self-insured or ERISA plans

  • Law will help end neglectful practices such as:

-Pre-existing condition exclusions
-Excessive waiting periods for coverage
-Rescissions of coverage
-Limits ability of insurers to place annual and lifetime dollar caps on coverage

Registration for health plans under the Affordable Care Act begins October 1, 2013 and must be completed by March 1, 2014 to avoid a penalty. To learn about how the Affordable Care Act with effect autism insurance coverage in your state please visit ourState Insurance Reform Initiatives Map. Each state’s information will detail whether or not ABA will be covered in that state under the Affordable Care Act and highlights information on past autism insurance reform, if applicable.

Visit the site or visit the Affordable Care Act Fact Sheets