52 Indiana’s Autism Spectrum Disorder Mandate

What is it?

The Indiana Legislature passed a law in July 2011 defining Pervasive Developmental Disorders (PDDs) as neurological disorders in accordance with the most recent edition of the Diagnostic and Statistical Manual (DSM). These include autistic disorder, Asperger’s Syndrome, Rett Syndrome, Childhood Disintegration Disorder and Pervasive Development Disorder (Not Otherwise Specified). This mandate requires that insurance providers provide coverage for individuals with ASD, or at least offer coverage as an option.

Who is covered?

The mandate covers any health or accident insurance policy that is issued on a group basis (small or large). Private insurers selling individual policies must offer the individual the option to include coverage for ASD, but this will likely be available at an additional cost. Also, private insurers can use their own medical necessity criteria and the insurance company may review the services ordered on the treatment plan.

Two Exceptions:

This law does not apply to self-insured companies. Your first step would be to contact your Human Resources Department and ask about their benefit information.

It also does not apply to companies that are headquartered in another state. The location of the headquarters is what determines insurance coverage and would be under the laws in that state and not Indiana. Contact your Human Resources Department and ask about their benefit information.

What is covered?

This law mandates that the treatment provided in your Care Plan must be prescribed by your child’s physician, developmental pediatrician, or psychiatrist. This Care Plan, or the outline of services needed, is submitted to the insurance provider by your doctor.

It is recommended to limit the Care Plan therapies to those that would be considered traditional therapies, or generally accepted by the medical community. The following would be considered traditional therapies and should be covered by the mandate:

• Behavior training
• Speech therapy
• Occupational therapy
• Physical therapy
• Medications for symptoms of ASD
• ABA therapy

To review a copy of the Autism Mandate, follow the steps below:

1. Go to www.in.gov
2. Click on Bills & Resolutions under Legislative in the lower left corner
3. Click on the down arrow next to Constitution and Statutes under Laws
4. Click on Indiana Code
5. Click on Title 27
6. Click on Article 8
7. Click on Chapter 14.2

Reference

Indiana Code 27-8-14.2 Available from http://iga.in.gov/legislative/laws/2019/ic/titles/027#27-8-14.2