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Learning Center Experience
Brian Craig, Full-Time Adjunct Faculty
2015, Georgia, Hawaii, Mississippi, North Carolina, and South Dakota all passed
autism insurance reform laws. North Carolina, the fifth state to adopt autism
insurance reform legislation, passed North Carolina Senate Bill 676 (also known
as the “Autism Health Insurance Coverage) in the final day of the legislative
session. The new law requires large group health plans to provide health care
benefits to cover the screening, diagnosis, and treatment of autism in youth
through age 18. The new North Carolina law, which will become effective July 1,
2016, applies only to insurance contracts renewed on or after the effective
date to companies that operate only in North Carolina with more than 50
employees and who do not “self-insure.”1
details vary for each state that enacted reform laws in 2015. The Mississippi
legislation, for example, requires coverage of autism-related services, for
children ages 2 to 8, with the possibility for additional coverage if deemed
medically necessary by a doctor. However,
the enacted state laws require certain health insurance plans to cover the
treatment of autism. Not all plan types are subject to state law and many state
autism insurance laws exclude certain plan types or impose age caps that may affect
43 states have now enacted some form of autism insurance coverage, coverage differs
widely from state to state.2
to the Centers for Disease Control and Prevention (CDC), autism is the
fastest-growing developmental disability, occurring in about 1 in 68 children across
all racial, ethnic, and socioeconomic groups.4
More than 3.5 million Americans live with an autism spectrum disorder. CDC also
notes that the prevalence of autism in U.S. children increased by 119.4% from
2000 (1 in 150) to 2010 (1 in 68).
With the increased rate and awareness of autism,
many legal and policy questions arise, especially in the context of state
insurance laws. In addition, there are states that have not yet adopted autism
insurance reform laws; this includes Alabama, Idaho, North Dakota, Ohio,
Oklahoma, Tennessee, and Wyoming. Individuals in states that have not yet
adopted autism insurance reform laws and individuals in states with only
limited coverage may wish to contact their state legislators to advocate
1Autism Speaks, North Carolina passes autism insurance reform legislation, Sept. 29, 2015, https://www.autismspeaks.org/advocacy/advocacy-news/north-carolina-passes-autism-insurance-reform-legislation.
2Autism Speaks, Autism Insurance Reform, https://www.autismspeaks.org/state-initiatives.
3See Jeffrey A. Cohen et. al., A Legal Review of Autism, A Syndrome Rapidly Gaining Wide Attention Within Our Society, 77 Alb. L. Rev. 389, 398-99 (2014).
4Centers for Disease Control and Prevention, Autism Spectrum Disorder, http://www.cdc.gov/ncbddd/autism/data.html.
Brian Craig is a full-time adjunct faculty member at Kaplan University. The views expressed in this article are solely those of the author and do not represent the view of Kaplan University.
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