Connecticut Passes Autism Coverage Legislation

Late last month, the Connecticut legislature passed S.B. 301 (the “Act”), which requires group health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders.  Specifically, policies must provide coverage for treatments that are medically necessary and prescribed by a licensed physician, licensed psychologist or licensed clinical social worker including:

(1)   Behavioral therapy;

(2)   Medically necessary medications prescribed by a licensed physician;

(3)   Direct psychiatric or consultative services provided by a psychiatrist licensed in the state in which such psychiatrist practices;

(4)   Direct psychological or consultative services provided by a psychologist licensed in the state in which such psychologist practices; and

(5)   Physical therapy, speech therapy and occupational therapy services provided by a medical professional licensed or certified to provide such services.

The Act allows insurers to place yearly limits on benefits at $50,000 for a child who is less than nine years of age and $35,000 for a child who is at least nine years of age and less than thirteen years of age, but prohibits insurers from limiting the number of medically necessary visits.

The Act is awaiting signature by Governor Rell and, once signed, will take effect on January 1, 2010.