MN HF1071

Health plans must provide coverage for diagnosis, evaluation, assessment, and medically necessary care of autism spectrum disorders that is evidence-based, including neurodevelopmental treatments, applied behavior analysis, speech therapy, occupational therapy, physical therapy, and prescription medications.

Coverage requires diagnosis through a comprehensive evaluation completed within six months prior to treatment, including medical and psychological evaluation by a licensed physician and psychologist, communication assessment by a speech pathologist, and comprehensive hearing test by an audiologist.

Covered treatments must be prescribed by a treating physician or mental health professional and supported by peer-reviewed research meeting specific criteria: randomized studies with sample size of 30+ per group showing statistically superior outcomes, or series of at least three single-case design experiments with robust experimental designs.

Early intensive behavior therapies must meet best practices standards including prescription by mental health professional, regular progress reporting, parent or guardian education and involvement, coordination with schools for children up to age 21, and provision by qualified mental health professionals, board-certified behavior analysts, or qualified behavioral aides.

Health plan companies cannot refuse to renew coverage or terminate an individual solely due to autism spectrum disorder diagnosis; treatment plan updates can only be requested once every six months unless both parties agree more frequent review is necessary.