State-by-State Guide to Insurance Laws Governing the Treatment of ASD with Applied Behavior Analysis

Over the past decade applied behavior analysis (ABA) has become widely-recognized as the most effective therapy for addressing the behavioral issues associated with autism. Thanks to the tireless efforts of applied behavior analysts and other therapists, along with the advocacy groups that work on their behalf, state legislators heard the appeals and responded overwhelming in support of autism insurance reform.

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To make these services fully accessible to families with autistic children and young adults, state legislators throughout the nation moved to classify ABA as a medically necessary form of therapy. This has brought the assurance that medical insurance providers would be required to cover the cost of ABA therapy, brining comfort to families with autistic children.

Amid the groundswell of support and resulting legislation in recent years, insurance laws have been enacted that differ widely from state to state in terms of age restrictions, coverage and visitation limits, and even the qualifications that ABA practitioners must hold in order for their services to be reimbursed.

We understand how important it is for ABAs to have a clear understanding of the insurance laws in their state. This quick reference guide uses clear language to provide the key points most relevant to ABAs and their clients, as well as links to the laws exactly as they were drafted by each state’s legislature.


Alabama—2012 Alabama Act, Act 298

  • Applies to all insurance plans that are delivered to employers with at least 51 employees for at least 50 percent of working days
  • Coverage is limited to $36,000 maximum per year
  • No visitation limits
  • Applies to individuals nine years of age or younger
  • Practitioner must be a board-certified behavior analyst (BCBA®)


Alaska—2012 Alaska Session Laws, Chapter 63

  • Applies to all insurers in the state, except for fraternal benefit societies or insurers providing insurance to a small employer in the group market with 20 or fewer employees
  • Coverage limit is subject to copayment, deductible, and coinsurance provisions included in individual health insurance policy
  • No visitation limits
  • Applies to individuals 21 years of age or younger
  • Practitioner must be state licensed and/or nationally certified as a board-certified behavior analyst (BCBA®)


Arizona—2008 Arizona Session Laws, Chapter 4

  • Applies only to certain health insurers in the state
  • Coverage limit is $50,000 a year for individuals age nine and under; $25,000 for individuals 9-16
  • No visitation limits
  • Applies to individuals 16 years of age and younger
  • Practitioner must be state licensed and/or nationally certified as a board-certified behavior analyst (BCBA®).


Arkansas—2011 Arkansas Acts, Act 196

  • Applies to all health benefit plans in the state
  • Coverage limit is $50,000 annually
  • No visitation limits
  • Applies to individuals 18 years of age and younger
  • Practitioner must be a board-certified behavior analyst (BCBA®) or supervised by a BCBA® and licensed by either Arkansas’s Division of Developmental Disabilities Services of the Department of Human Services or the Arkansas Board of Examiners in Counseling


California—2011 California Stats, Chapter 650

  • Applies to all disability insurance plans and all health care service plans that provide hospital, medical, or surgical coverage in the state
  • Coverage limit may not exceed ABA coverage provided by the Patient Protection and Affordable Care Act
  • No visitation limits
  • No age restriction
  • Practitioner must be licensed or certified by a national entity, such as the Behavior Analyst Certification Board


Colorado—2009 Colorado Session Laws, Chapter 391; SB 244 of 2009, Fiscal Note

  • Applies to all health benefit plans in the state
  • No coverage limit
  • No visitation limits
  • No age restriction
  • Practitioner must be a licensed physician, psychologist or psychiatrist, hold a doctoral degree in behavior health science and have one year of behavioral therapy experience, or hold the board-certified behavior analyst certification (BCBA®), or hold the board-certified assistant behavior analyst certification and practice under the supervision of a BCBA®


Connecticut—Connecticut Insurance Department 2014 Bulletin

  • Applies to specified group health insurance policies
  • No coverage limits
  • Visitation and non-dollar limits established by individual policies
  • Applies to individuals 15 years of age and younger
  • Practitioner must be a board-certified behavior analyst (BCBA®), a licensed psychologist, a licensed physician, or supervised by a BCBA®


Delaware—2012 Delaware Laws, Senate Bill 22

  • Applies to all health insurance plans in the state
  • Coverage is limited to $36,000 annually
  • No visitation limits
  • Applies to individuals age 21 and younger
  • Practitioner must be a board-certified behavior analyst or working under the supervision of a BCBA®


District of Columbia—2013 District of Columbia B20-0302

  • Applies to specified group health insurance policies and individual plans
  • Coverage limit is the same as for other treatments/therapies
  • No visitation limits
  • No age limits
  • Practitioner must be nationally certified as a board-certified behavior analyst (BCBA®)


Florida—Florida Laws, Chapter 30: SB 2654 of 2008; 2016 Florida Bill 0221

  • Applies to all health insurance plans and health maintenance contracts, and includes coverage for autism spectrum disorders as well as Down Syndrome
  • Coverage is limited to $36,000 annually and $200,000 in total lifetime benefits
  • No visitation limits
  • No age restriction
  • Practitioner must be nationally certified as a board-certified behavior analyst (BCBA®)


Georgia—2015 Georgia House Bill 429

  • Applies to state-regulated private insurance companies’ group policies
  • Coverage is limited to $30,000 annually
  • No visitation limits
  • Applies to individuals age six and under
  • Practitioner must be nationally certified as a board-certified behavior analyst (BCBA®) or working under the supervision of a BCBA®


Hawaii—2015 Hawaii Laws, Senate Bill 791

  • Applies to all state-regulated health insurance plans
  • Coverage is limited to $25,000 annually
  • No visitation limits
  • Applies to individuals 13 years of age and younger
  • Practitioner must be a board-certified behavior analyst (BCBA®) and licensed through Hawaii’s Department of Commerce and Consumer Affairs’ Professional and Vocational Licensing Division


Idaho

  • Idaho’s insurance laws do not require insurers to cover ABA therapy.


Illinois—Illinois Statute 215 ILCS

  • Applies to all individual and group accident and health insurance or managed care plans in the state
  • Coverage limit is $44,877 per year (figure from 2016; figure to be adjusted annually for inflation)
  • No visitation limits
  • Applies to individuals 21 years of age and younger
  • Practitioner must be a licensed physician or a certified health care professional. Legislation expected to pass in 2017 will require practitioner to hold national certification as a board-certified behavior analyst.


Indiana—Indiana Code 27-8-14.2-1

  • Applies to all group accident and sickness insurance policies in the state
  • No coverage limit
  • No visitation limits
  • No age restriction
  • Practitioner must be a board-certified behavior analyst (BCBA®)


Iowa—Iowa House File 2531 of 2010

  • Applies to all state employee health care plans in the state
  • Coverage is limited to $36,000 per year
  • No visitation limits
  • Applies to individuals age 21 and younger
  • Practitioner must be a board-certified behavior analyst (BCBA®) or performed by a board-certified assistant behavior analyst under the supervision of a BCBA®


Kansas—2014 Kansas House Bill No. 2744

  • Applies to all health insurance plans that cover medical, surgical or hospital expense coverage in the state
  • Coverage is limited to 1300 hours for children under 4 and 520 hours for children from 4-12
  • No visitation limits
  • Applies to individuals age 12 and under
  • Practitioner must be a board-certified behavior analyst (BCBA®)


Kentucky—Kentucky Revised Statutes 304.17A-142

  • Applies to all state employee health benefit plans and large group health benefit plans in the state
  • Coverage is limited to $50,000 for children ages 1-7, and $1,000 per month per individual for children ages 7-21.
  • No visitation limits
  • Applies to individuals ages 1-21
  • Practitioner must be a board-certified behavior analyst licensed by the Kentucky Applied Behavior Analysis Licensing Board or a supervisee working under the supervision of a BCBA® or BCaBA®.


Louisiana—Louisiana House Bill 771 2012

  • Applies to all health insurance policies and health maintenance organizations except those employers with 10 or fewer employees
  • Coverage is limited to $36,000 per year
  • No visitation limits
  • Applies to individuals 21 years of age and under
  • Practitioner must be licensed or certified by the Louisiana Behavior Analyst Board


Maine—2014 Maine Laws, LD 347

  • Applies to all individual health insurance policies, group health insurance policies, and individual and group health maintenance organization contracts
  • Coverage is limited to $36,000 per year
  • No visitation limits
  • Applies to individuals age 21 and under
  • Practitioner must be a licensed clinical psychologist, or certified through the Behavior Analyst Certification Board or the Association of Professional Behavior Analysts


Maryland—2012 Maryland Insurance Administration Insurance Article 2-109

  • Applies to all insurers, health benefit plans, nonprofit health service plans, and health maintenance organizations in the state
  • No coverage limits
  • No visitation limits
  • Applies to individuals age 19 and under
  • Practitioner must be a board-certified behavior analyst (BCBA®)


Massachusetts—2010 Massachusetts Acts, Chapter 207

  • Applies to specified individual, group and state employee health plans in the state
  • No coverage limit
  • No visitation limits
  • No age restriction
  • Practitioner must be a board-certified behavior analyst or supervised by a board-certified behavior analyst


Michigan—2012 Michigan Public Acts, Act 100

  • Applies to all individual health policies and health maintenance organization plans in the state
  • Coverage is limited to $50,000 for children up to age six, $40,000 for children ages 7-12, and $30,000 for children ages 13-18.
  • No visitation limits
  • Applies to individuals 18 years of age and younger.
  • Practitioner must be a psychologist licensed to practice in the state of Michigan


Minnesota—2013 Minnesota Law, HF 1233, Article 12

  • Applies to all state employee health plans, fully insured large group plans, Medicaid, and Minnesota Comprehensive Health Association high risk plans
  • No coverage limits
  • No visitation limits
  • Applies to individuals 18 years of age and younger.
  • Practitioner must be licensed or certified


Mississippi—2015 Mississippi Laws, HB 885

  • Applies to all health insurance plans in the state
  • Coverage is not limited
  • Visitation in limited to 25 hours per week.
  • Applies to individuals ages 2-8, except if deemed medically necessary by a doctor after the age of eight
  • Practitioner must be a board-certified behavior analyst or supervised by a board-certified behavior analyst


Missouri—Missouri House Bill 1311

  • Applies to all group health benefit plans in the state and individual policies as an optional benefit for an additional premium
  • Coverage is limited to $40,00 per year except with approval by the health benefit plan, to be annually adjusted each year from 2010 onward
  • No visitation limits
  • Applies to individuals eighteen years of age and younger
  • Practitioner must be a board-certified behavior analyst


Montana—2009 Montana Laws, Chapter 359, SB 234 of 2009

  • Applies to specified disability and insurance policies
  • Coverage limited to $50,00 per year for children 8 years old and younger, $20,000 for children 9-18
  • No visitation limits
  • Applies to individuals 18 years old and younger
  • Practitioner must be a board-certified behavior analyst or be certified by the department of public health and human services as a family support specialist with an autism endorsement


Nebraska—2014 Nebraska Laws, LB 254; 2016 Medicaid Mandate

  • Applies to state employee health plans, full insured large group plan, and individuals plans, Medicaid plans, and fully insured small group plans purchased prior to March 23, 2010
  • No coverage limits
  • Visitation limited to 25 hours a week
  • Applies to individuals 20 years old and younger
  • Practitioner must be a licensed psychologist or a behavior analyst certified by a national board such as the Behavior Analyst Certification Board


Nevada—2015 Nevada A.B. 6

  • Applies to individual health benefit plans, health insurance for small employers, group and blank health insurance benefit plans, and health maintenance organization plans in the state
  • Coverage is limited to $72,000 annually
  • No visitation limits
  • Applies to individuals 18 years old and younger or 21 if enrolled in high school
  • Practitioner must be a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst or certified autism behavior interventionist


New Hampshire—2010 New Hampshire Laws, House Bill 569, Chapter 363

  • Applies to specified insurers in the state
  • Coverage is limited to $36,000 per year for children up to 12 years and $27,00 for children ages 13-21
  • No visitation limits
  • Applies to individuals 21 years old and younger
  • Practitioner must be a board-certified behavior analyst or supervised by a BCBA®


New Jersey—2009 New Jersey Laws, Chapter 115, AB 2238

  • Applies to specified insurers in the state
  • No coverage limits
  • No visitation limits
  • Applies to individuals 21 years old and younger
  • Practitioner must be a board-certified behavior analyst (BCBA®) or supervised by a BCBA®


New Mexico—2009 New Mexico Laws, Chapter 74, SB 39 of 2009

  • Applies to specified insurance policies, health care plans, and certificates of heath insurance in the state
  • Coverage is limited to $36,000 annually and $200,000 in total lifetime benefits
  • No visitation limits
  • Applies to individuals 19 years old and younger or up to age 22 if enrolled in high school
  • Practitioner must be licensed or certified


New York—New York Autism Insurance Reform Law

  • Applies to every insurance policy which provides physician services, medical, major medical or similar comprehensive coverage
  • Coverage is limited to $45,000 annually
  • No visitation limits
  • No age limits
  • Practitioner must be licensed through the New York State Education Department (NYSED)


North Carolina—2015 North Carolina Laws, SB 676

  • Applies to all large group health insurance plans in the state
  • Coverage is limited to $40,000 annually
  • No visitation limits
  • Applies to individuals 18 years of age and younger
  • Practitioner must be licensed as a psychologist by the North Carolina Psychology Board or practicing under the supervision of a licensed psychologist


North Dakota—North Dakota State Plan for Autism Spectrum Disorders and Preventative Care

  • Applies to Medicaid plans in the state
  • No coverage limits
  • No visitation limits
  • Applies to individuals ages 21 and younger
  • Practitioner must be licensed by the North Dakota State Board of Psychologist Examiners (NDSBPE)


Ohio—Governor’s Insurance Policy Directive, 2012

  • Applies to health plans for state employees, as well as some individual plans
  • No coverage limits
  • Visitation is limited to a maximum weekly amount of 20 hours
  • Applies to individuals 0-21 years
  • Practitioner must be a Certified Ohio Behavioral Therapist (COBT), which can be met by Board-Certified Behavior Analyst (BCBA®) requirements


Oklahoma—Oklahoma House Bill 2962

  • Applies to all individual and group health insurance policies that provide medical/surgical benefits as well as state employee health plans
  • Coverage limited to $25,000 annually (to be adjusted annually)
  • Visitation limited to 25 hours per week
  • Applies to individuals 9 years and younger. If the individual is not diagnosed or treated until after three years of age, care must be covered for six years
  • Practitioner must be a board-certified behavior analyst and licensed by the Oklahoma Licensed Behavior Analyst Board (OLBAB)


Oregon—2013 Oregon Laws, SB 365

  • Applies to specified health benefit plans, state employee health plan, fully insured large group plans and fully insured small group plans
  • No coverage limits
  • Visitation is limited to 25 hours per week
  • Treatment must begin prior to nine years of age; no age limits
  • Practitioner must be a board-certified behavior analyst or other licensed health care professional and licensed by Oregon’s Behavior Analysis Regulatory Board


Pennsylvania—Pennsylvania Laws, Act 2008-62, HB 1150 of 2008, Mandated Benefits Review

  • Applies to all health insurance policies and government programs
  • Coverage is limited to $36,000 annually
  • No visitation limits
  • Applies to individuals 21 years of age and younger
  • Practitioner must be licensed or certified through the Pennsylvania State Board of Medicine


Rhode Island—2011 Rhode Island Public Laws, Chapter 175

  • Applies to specified health insurance contracts and policies
  • Coverage is limited to $32,000 annually
  • No visitation limits
  • Applies to individuals 15 years of age and younger
  • Practitioner must be licensed or certified by Rhode Island’s Applied Behavior Analyst Licensing Board


South Carolina—2007 South Carolina Code 38-71-280

  • Applies to all health insurance plans in the state
  • Coverage limited to $50,000 annually
  • No visitation limits
  • Applies to individuals who were diagnosed with ASD at 8 or younger and are 16 or younger
  • No state licensing laws regarding ABAs, but the BCBA® credential is routinely required by employers.


South Dakota—South Dakota 2015 Laws, SB 190

  • Applies to all health insurance plans in the state
  • Coverage limited to $36,000 for children through the age of six, $25,000 from ages 7-13, and $12,500 for ages 14-18.
  • No visitation limits
  • Applies to individuals age 18 and younger
  • Practitioner must be licensed by the South Dakota Social Work Licensing Board


Tennessee—2006 Tennessee Public Acts, Chapter 894, Tennessee Code Ann. 56-7-2367

  • Applies to all health insurance policies that provide benefits for neurological disorders
  • Coverage is limited to deductible requirements for other neurological disorders
  • No visitation limits
  • Applies to individuals 12 years of age and younger
  • Practitioner must be a board-certified behavior analyst and licensed by the Applied Behavior Analyst Licensing Committee


Texas—Texas Insurance Code 1355.015

  • Applies to all health benefit plans in the state
  • Coverage is limited to annual deductibles, copayments and coinsurance required for other treatment under the health benefit plan
  • No visitation limits
  • Applies to individuals who are nine years of age and younger
  • Practitioner must be a licensed or certified health care practitioner or acting under the supervision of a licensed or certified practitioner (legislation expected to pass in 2017 will clarify that practitioner be a board-certified behavior analyst)


Utah—2014 Utah Law, SB 57

  • Applies to all individual and full insured large group plans in the state
  • No coverage limits
  • Visitation is limited to 600 hours per year or 11.5 hours per week
  • Applies to individuals who are 2-10 years old
  • Practitioner must be a board-certified behavior analyst or other licensed health professional whose scope of practice includes mental health services, licensed by the state’s Department of Occupations and Licensing


Vermont—2012 Vermont Acts, Act 158

  • Applies to all health insurance plans in the state
  • Coverage is required to not exceed benefits offered under the Patient Protection and Affordable Care Act
  • No visitation limits
  • Applies to individuals who are 21 years of age and younger
  • Practitioner must be a board-certified behavior analyst or licensed by Vermont’s Office of Professional Regulation


Virginia—2015 Virginia Acts, Chapter 650

  • Applies to health insurers, health care subscription plans and health maintenance organizations
  • Coverage is limited to $35,000 annually unless specified a higher amount by the insurer
  • No visitation limits
  • Applies to individuals from ages 2-10
  • Practitioner must be a board-certified behavior analyst and licensed by the Virginia Board of Medicine


Washington—Senate Bill 5059

  • Applies to all insurers operating in the state
  • No coverage limits
  • No visitation limits
  • No age restrictions
  • Practitioner must be licensed or certified (BCBA® not specified, but clarification expected when new licensing laws take effect July 2017)


West Virginia—2011 West Virginia Act, Chapter 13

  • Applies to specified health insurers, including the West Virginia Children’s Health Insurance Program
  • Coverage is limited to $30,000 per year for the first three years of treatment and $2,000 per month after three years
  • No visitation limits
  • Applies to individuals diagnosed with ASD at age 8 or younger, from 18 months to 18 years
  • Practitioner must be a board-certified behavior analyst or certified by a similar national organization


Wisconsin—Wisconsin Statues 632.895 and 609.87, 2009 Wisconsin Laws, Act 28

  • Applies to specified disability policies and self-insured health plans in the state
  • Coverage limited to $50,000 per year for four years for intensive services and $25,000 per year for non-intensive services
  • No visitation limits
  • Intensive level services only apply to children from ages 2-9. No age requirements for non-intensive level services
  • Practitioner must be a board-certified behavior analyst and licensed by the Wisconsin Department of Safety and Professional Services


Wyoming—Wyoming Department of Health State Medicaid Policy

  • Applies to Medicaid programs in the state
  • No coverage limits
  • Visitation is limited to 20 visits annually, unless otherwise specified by a medical professional
  • Applies to individuals age 20 and younger
  • Practitioner must be a board-certified behavior analyst, a board-certified assistant behavior analyst, or a registered behavior technician under the supervision of a BCBA®

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