Pennsylvania health insurers still can apply “general exclusions and limitations” to coverage for plan members who are dealing with autism, officials say.
The Pennsylvania Insurance Department has issued guidance on Pennsylvania’s autism coverage mandate law, Act 62.
The law “mandates coverage of the ‘treatment of autism spectrum disorders,’ and defines that term to include ”medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative care and therapeutic care,’ prescribed and provided” in connection with treatment of autism spectrum disorders, department officials write in Notice 2009-03.
But insurers can continue to apply exclusions and limitations for other types of medical care that people with autism receive, officials write.
“By way of example, if a policy generally excludes acupuncture treatment, and an autism provider believes that acupuncture may provide some benefit to his autism patient, that particular treatment may nonetheless be excluded from the mandated coverage,” officials write.
“If a policy or contract requires all medical services to be provided by a participating provider as a prerequisite for payment of services, autism services may also be required to be provided by a participating provider as a prerequisite for payment of those services,” officials write.
But insurers cannot put specific limitations on number of visits for autism-related treatments, even if the insurers would impose those numerical limits on other types of care, officials write.