Summary of Virginia Legislation

Courtesy of Autism Votes, an Autism Speaks initiative.

Summary of Virginia Legislation:

House Bill 303 – Sponsored by Delegate John M. O’Bannon III

Senate Bill 464 – Sponsored by Senator Janet D. Howell

Would require health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders for individuals age 9 and younger (the bill does not preclude the extension of coverage for individuals age 10 and up)

Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary

Under this bill, health insurance companies would be required to provide coverage of the following:

  • Diagnosis of an autism spectrum disorder – meaning medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing, or other testing to determine whether an individual has one or more autism spectrum disorders
  • Habilitative or rehabilitative care – meaning professional counseling, guidance, services, and treatment programs, including applied behavior analysis (ABA) and other behavioral health treatments, that are necessary to develop, maintain, and restore to the maximum possible extent an individuals functioning
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care – meaning services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists, or social workers

The bill does not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan

Employers with fewer than 50 employees are exempt from this bill

The bill applies only to state regulated insurance plans. It does not apply to self-funded insurance plans as these plans are regulated by the federal government under ERISA law

The bill would apply to health insurance coverage offered to state employees beginning July 1, 2015

If enacted, this bill would take effect on January 1, 2011

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