SB 22 - Autism Spectrum Disorders Coverage

• Requires all individual and group health benefit plans in Delaware to cover screening, diagnosis, and treatment of autism spectrum disorders for individuals under 21 years of age, effective 120 days after enactment.

• Sets maximum benefit of $36,000 per 12-month period for applied behavior analysis services, with no limits on number of visits; Insurance Commissioner shall adjust maximum annually based on Consumer Price Index (CPI-U).

• Prohibits insurers from denying, terminating, or refusing coverage based on autism spectrum disorder diagnosis or treatment; coverage cannot be denied as habilitative or nonrestorative.

• Defines covered treatments to include behavioral health treatment, pharmacy care, psychiatric care, psychological care, therapeutic care, and equipment necessary for treatment; allows Secretary of Department of Health and Social Services to determine additional medically necessary care.

• Requires Department of Health and Social Services to establish provider certification standards within 6 months; Board Certified Behavior Analysts automatically meet standards.