SB1592 Summary

• Prohibits insurers from denying coverage for autism spectrum disorder diagnosis and treatment for individuals under 21 years of age in group or individual health insurance policies and managed care plans amended, delivered, issued, or renewed after the effective date.

• Sets maximum annual benefit of $36,000 per year for autism spectrum disorder coverage, adjusted annually for inflation using the Medical Care Component of the Consumer Price Index, with no limits on number of visits to service providers.

• Prevents insurers from denying services or terminating coverage based solely on the location where clinically appropriate services are provided for both autism spectrum disorders and habilitative services.

• Requires insurers to make medical necessity determinations for autism spectrum disorder treatments consistent with determinations for other diseases, with appeals reviewed by physicians with expertise in current autism treatment modalities.

• Mandates coverage for habilitative services (occupational, physical, speech therapy and other services) for children under 19 with congenital, genetic, or early acquired disorders including autism spectrum disorders when prescribed by physicians and administered by licensed professionals.