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At the conclusion of the last legislative session, the West Virginia legislature
passed HB 2693, the West Virginia Autism Insurane Reform Bill. The bill was
signed into law by acting governor Earl Ray Tomblin, and becomes effective
January 1, 2012. Please see below for additional details!
passed HB 2693, the West Virginia Autism Insurane Reform Bill. The bill was
signed into law by acting governor Earl Ray Tomblin, and becomes effective
January 1, 2012. Please see below for additional details!
WV Autism Insurance FAQ
West Virginia’s Autism Insurance Reform Law
(House Bill 2693)
Effective Date for PEIA: July 1, 2012
*This law does not include Medicaid/medical cards.
Effective Date for all other providers: As policies renew on or after
January 1, 2012. Mandate applies to
companies with more than 25 employees.
WHO IS COVERED:
Individuals 18 months to 18 years of age. The individual must be diagnosed
with an Autism Spectrum Disorder at
age 8 or younger.
WHAT IS COVERED:
Treatments that are medically necessary and ordered or prescribed by a
licensed physician or licensed psychologist.
WHAT ARE THE STIPULATIONS FOR Applied Behavior Analysis
Services (ABA)
A Board Certified Behavior Analyst (BCBA) must develop a treatment plan
which includes:
1. A comprehensive evaluation or reevaluation of the individual, subject to
review by the insurance agency
every six months.
2. Progress reports are required to be filed with the insurance agency semi-
annually.
3. In order for treatment to continue, the agency must receive objective
evidence or a clinically supportable
statement of expectation that:
a) The individual’s condition is improving in response to treatment, and
b) A maximum improvement is yet to be attained, and
c) There is an expectation that the anticipated improvement is attainable
ANNUAL MAXIMUM BENEFIT: $30,000 for 3 consecutive years from the
date treatment starts for children
between 18 months and 8 years of age. At the conclusion of the third year,
required coverage shall be in an amount
not to exceed $2,000 per month up to age 18.
CAN PUBLICLY FUNDED PROGRAMS SUCH AS SCHOOLS BILL
INSURANCE FOR SERVICES:
No. These services in no way replace those provided by the school system
or other publicly funded programs.
Services reimbursed through insurance shall not be construed as limiting,
replacing or affecting any obligation
to provide services to an individual under the Individuals with Disabilities
Education Act, 20 U.S.C. 1400 et
seq., or other publicly funded programs. Services provided by school
personnel are not eligible for insurance
reimbursement.
COPAY AMOUNTS AND REIMBURSEMENT RATES FOR SERVICES:
These have not yet been established and may be different for each
insurance company.
CURRENT BARRIERS:
Unfortunately there are some issues that have recently come to our
attention that need resolution as soon as possible
to enact this insurance bill as it was intended by our legislators. MAP will be
gathering information and passing it
on to you as soon as the details become available. Your time, voice, and
presence will be needed again this year to
ensure that WV children with autism will get the medically necessary
treatments that they need and deserve.
Effective Date for CHIP: July 1, 2012
West Virginia’s Autism Insurance Reform Law
(House Bill 2693)
Effective Date for PEIA: July 1, 2012
*This law does not include Medicaid/medical cards.
Effective Date for all other providers: As policies renew on or after
January 1, 2012. Mandate applies to
companies with more than 25 employees.
WHO IS COVERED:
Individuals 18 months to 18 years of age. The individual must be diagnosed
with an Autism Spectrum Disorder at
age 8 or younger.
WHAT IS COVERED:
Treatments that are medically necessary and ordered or prescribed by a
licensed physician or licensed psychologist.
WHAT ARE THE STIPULATIONS FOR Applied Behavior Analysis
Services (ABA)
A Board Certified Behavior Analyst (BCBA) must develop a treatment plan
which includes:
1. A comprehensive evaluation or reevaluation of the individual, subject to
review by the insurance agency
every six months.
2. Progress reports are required to be filed with the insurance agency semi-
annually.
3. In order for treatment to continue, the agency must receive objective
evidence or a clinically supportable
statement of expectation that:
a) The individual’s condition is improving in response to treatment, and
b) A maximum improvement is yet to be attained, and
c) There is an expectation that the anticipated improvement is attainable
ANNUAL MAXIMUM BENEFIT: $30,000 for 3 consecutive years from the
date treatment starts for children
between 18 months and 8 years of age. At the conclusion of the third year,
required coverage shall be in an amount
not to exceed $2,000 per month up to age 18.
CAN PUBLICLY FUNDED PROGRAMS SUCH AS SCHOOLS BILL
INSURANCE FOR SERVICES:
No. These services in no way replace those provided by the school system
or other publicly funded programs.
Services reimbursed through insurance shall not be construed as limiting,
replacing or affecting any obligation
to provide services to an individual under the Individuals with Disabilities
Education Act, 20 U.S.C. 1400 et
seq., or other publicly funded programs. Services provided by school
personnel are not eligible for insurance
reimbursement.
COPAY AMOUNTS AND REIMBURSEMENT RATES FOR SERVICES:
These have not yet been established and may be different for each
insurance company.
CURRENT BARRIERS:
Unfortunately there are some issues that have recently come to our
attention that need resolution as soon as possible
to enact this insurance bill as it was intended by our legislators. MAP will be
gathering information and passing it
on to you as soon as the details become available. Your time, voice, and
presence will be needed again this year to
ensure that WV children with autism will get the medically necessary
treatments that they need and deserve.
Effective Date for CHIP: July 1, 2012
Other important documents: