Use of Private Insurance for Early Intervention Services
Under 34 CFR §303.520(3)(b), a state may use the private insurance of a parent to pay for services under this part only if the parent provides consent to do so in accordance with 34 CFR §303.7 (parental consent), 34 CFR §303.420(a)(3) (consent prior to provision of services), and 34 CFR §303.420(a)(4) (use of private insurance).
Under 34 CFR §303.521(c), if a State has in effect a State law requiring the provision of a Free Appropriate Public Education (FAPE) to children with disabilities from birth, the State may not charge parents for any services (e.g., physical or occupational therapy) that are part of FAPE for that infant or toddler and family.
Requires coverage of Part C services by public medical assistance and private health insurance up to $6,067, including case management costs, per calendar or policy year.
Requires coverage of Part C services up to $6,400 per child per year and an aggregate benefit of $19,200 per child over the total three-year period. Group insurance policies have an exemption to the expense limit for children with autism spectrum disorder, who have a maximum benefit available through early intervention providers of $50,000 per child per year and an aggregate benefit of $150,000 per child over the total three-year period. These costs are exempt from:
- being applied against or result in a loss of benefits due to any maximum lifetime or annual limits specified in the policy;
- adversely affecting the availability of health insurance to the child, the child's parent or the child's family members insured under any such policy; or
- being a reason to rescind or cancel such policy.
Requires insurers to reimburse early intervention services if they are otherwise covered under a policy and exempts these payments from counting against any lifetime caps.
Mandates that both indemnity and managed care plans cover early intervention.
- Provisions Respecting Domestic Companies (2011) (page 1)
- Non-Profit Hospital Service Corporations (2011) (page 3)
- Medical Service Corporations (2011) (page 5)
- Health Maintenance Organizations (2011) (page 7)
Requires coverage for Children's Early Intervention Therapy Services up to $3,200 per child per year not to exceed $9,600 by the child's third birthday.
Requires coverage of Part C services up to $5,000 annually per dependent child and exempts these costs from counting against any lifetime cap in a family's policy.
- Accident and Sickness Insurance Policies
- Non-Profit Medical Service Corporations
- Non-Profit Hospital Service Corporations
Requires coverage of Part C services up to $5,000 annually and exempt these costs from counting against any lifetime caps in a family's policy. The state also applies these provisions in a separate act to the insurance program for state employees.
Health Insurance Legislation for Autism Spectrum Disorders (ASD)
Several states have enacted insurance legislation specific to autism spectrum disorders or have modified existing legislation to further define neurological disorders to include ASD for the purpose of covering needed services for eligible children. The following resources describe state health insurance legislation for ASD:
State Health Insurance for Autism Spectrum Disorders (ASD) (2009)
Easter Seals: State Autism Profiles
- state insurance coverage for autism if available;
- the number of children with autism who have received the state's special education services;
- Medicaid services specific for individuals with autism;
- educational programs provided to students with autism or training that focused on autism;
- special education criteria;
- other state-led resources; and
- sponsors of autism legislation.