HB2174 Summary

• Requires health insurers, mutual benefit societies, and health maintenance organizations to provide coverage for screening, diagnosis, and evidence-based treatment of autism spectrum disorders for individuals under a specified age, effective July 1, 2014.

• Coverage for behavioral health treatment is subject to a maximum benefit of $50,000 per year and $300,000 lifetime, with no limits on visits to autism service providers; the insurance commissioner must adjust these limits annually for inflation.

• Insurers must include at least as many board-certified behavior analysts as licensed psychologists in their provider networks and may only include providers who have cleared criminal background checks.

• Coverage may be subject to copayment, deductible, and coinsurance provisions no less favorable than other medical services, and cannot be denied based on treatment being habilitative or non-restorative in nature.

• Treatment includes behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care when prescribed by licensed physicians or other qualified professionals and determined to be medically necessary.