Late last month, the New Jersey legislature passed A2238/S1651 (the “NJ Act”), which requires group health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders. Specifically, policies must provide coverage for treatments that are deemed medically necessary by the autistic person’s physician including behavioral therapy, physical therapy, speech therapy, and occupational therapy. Benefits for the year 2011 are limited to $36,000 a year for individuals under 21 years of age. The cap is subject to adjustment each subsequent year based on the consumer price index. The NJ Act is awaiting signature by Governor Corzine and, once signed, will make New Jersey the fifteenth state to enact such legislation. For the complete text of the NJ Act, click here.
Massachusetts is also considering similar legislation, H.3809 (the “MA Act”), that requires health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders. “Diagnosis” is defined as “medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has one of the autism spectrum disorders,” while “treatment” includes medically necessary habilitative or rehabilitative care, pharmacy care, psychiatric care, psychological care, and therapeutic care. The MA Act caps yearly/lifetime autism benefits equal to the insurance policy’s current cap for the diagnosis and treatment of other physical conditions. The MA Act has been referred to the Joint Committee on Financial Services. A date for a House floor hearing has not yet been set. For the complete text of the MA Act, click here.