Last week, the Massachusetts legislature passed House Bill No. 4935, An Act relative to insurance coverage for autism (“H. 4935”), which requires that benefits be provided on a nondiscriminatory basis for the diagnosis and treatment of Autism Spectrum Disorders.  H. 4935 prohibits dollar or unit of service limitations on coverage for the diagnosis and treatment of autism that are lower than dollar or unit of service limitations applicable to the diagnosis and treatment of physical conditions.

Autism services provided by school personnel pursuant to an individualized education program are not subject to reimbursement under H. 4935.  In addition, insurers may be exempt from covering the habilitative and rehabilitative care required under H. 4935 if (i) the cost of such care would exceed 1% of the premiums charged by the insurer, and (ii) the cost of such care would lead to an increase in average premiums charged of more that 1% for all insurance policies.

H. 4935 is awaiting signature by Governer Patrick and, if signed, would make Massachusetts the 23rd state to enact such legislation.  For the complete text of H. 4935, click here.