Receiving an autism diagnosis is a pivotal moment for individuals and families in Oklahoma. Understanding the landscape of insurance coverage for autism spectrum disorder (ASD) is crucial for accessing necessary care and support. Oklahoma has taken significant steps to ensure that state-regulated health plans provide meaningful coverage for autism diagnosis and treatment. This article breaks down the key aspects of Oklahoma’s autism insurance law, ensuring you have the information you need to navigate this process.
Oklahoma’s commitment to autism coverage is embodied in House Bill 2962 (HB 2962), enacted in 2016. This legislation mandates that certain insurance plans in Oklahoma cover the screening, diagnosis, and treatment of Autism Spectrum Disorder (ASD). Initially taking effect on November 1, 2016, the law has been further strengthened to remove previous limitations on benefits, ensuring more comprehensive support for Oklahomans with autism.
Which Insurance Plans in Oklahoma are Required to Cover Autism Diagnosis and Treatment?
It’s important to understand which types of insurance plans in Oklahoma are subject to the state’s autism insurance law. The law applies to the following categories:
- Individual Grandfathered Plans: Yes
- Fully Insured Large Group Plans: Yes
- Fully Insured Small Group Grandfathered Plans: Yes
However, it’s equally important to note which plans are not mandated to adhere to the state law:
- Individual Non-Grandfathered Plans: No
- Fully Insured Small Group Non-Grandfathered Plans: No
What Autism Services are Covered Under Oklahoma Law?
Oklahoma law ensures coverage for a wide range of essential services related to autism spectrum disorder. These covered services are vital for individuals throughout their journey, from initial assessment to ongoing therapy and support. The mandated services include:
- Screening for Autism Spectrum Disorder
- Diagnosis of Autism Spectrum Disorder
- Treatment of Autism Spectrum Disorder
- Pharmacy Care related to ASD
- Psychiatric Care for co-occurring mental health conditions
- Psychological Care
- Therapeutic Care, including various therapies tailored to individual needs
- Behavioral Health Treatment
- Applied Behavior Analysis (ABA) therapy, a widely recognized and effective treatment for autism
Removal of Coverage Caps: Expanding Access to Autism Services in Oklahoma
Originally, Oklahoma’s autism insurance law included limitations on coverage, such as age and annual benefit caps. The 2016 legislation initially limited coverage to at least six years of treatment, or up to age nine if diagnosed or accessing care before age three. Furthermore, Applied Behavior Analysis (ABA) therapy was subjected to a maximum annual benefit of $25,000 and a limit of 25 hours per week.
However, significant progress was made in August 2021 when the Oklahoma Insurance Department issued a bulletin. This bulletin declared these previous limitations as violations of the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA ensures that mental health and substance use disorder benefits are not more restrictive than medical/surgical benefits offered by health plans.
As a result of this bulletin, Oklahoma-regulated insurance policies were required to eliminate these coverage caps by December 31, 2021. This landmark change means that Oklahomans with autism now have access to more comprehensive and less restricted insurance coverage for medically necessary autism services, removing previous barriers to care.
For further inquiries regarding autism insurance coverage in Oklahoma, individuals are encouraged to reach out to advocacy resources for personalized guidance and support.
