New Massachusetts State Laws

Autism Spectrum Disorders Treatment

In accordance with the State Act (An Act Relative to Insurance Coverage for Autism) effective January 1, 2011, NHP will cover the diagnosis and treatment of Autism Spectrum Disorder in members, including Autistic Disorder, Asperger's Disorder and other pervasive developmental disorders.

Diagnosis and Treatment

The diagnosis includes medically necessary assessments, evaluations (including neuropsychological evaluations) and genetic testing. Treatment includes the following as long as it is prescribed, provided or ordered by a licensed physician or psychologist:

• habilitative or rehabilitative care (including applied behavior analysis)
• pharmacy care
• psychiatric care
• psychological care
• therapeutic care (provided by licensed or certified speech, occupational or physical therapists, or social workers)

Limits

Coverage is nondiscriminatory in that it does not contain any annual or lifetime dollar or unit of service limits which are less than similar limits imposed on the diagnosis and treatment of physical conditions. Additionally, there are no limits on the number of visits that a member may make to an autism provider (including speech, occupational or physical therapists).

Please note that the Act does not impact the provision of services to members under an individualized family service plan (Early Intervention), individualized education program (Special Education) or individualized service plan.