Massachusetts became the 23rd state to pass legislation expanding health insurance coverage to children and adults with an Autism Spectrum Disorder (ASD). The law which was approved by the Governor on August 3, 2010, went into effect on January 1, 2011. With students returning to schools across the Commonwealth, it is important to explain what is and is not covered by the new law, and what schools’ obligations continue to be under the Individuals with Disabilities Education Act (IDEA).
ARICA (An Act Relative to Insurance Coverage for Autism) mandates specific private health insurance providers to cover an expanded range of services for those on the Autism Spectrum. In particular, the law requires these insurance companies to cover “medically necessary” care including: habilitative or rehabilitative care, pharmacy care, psychiatric care, psychological care and therapeutic care.
ARICA is only applicable in Massachusetts, so it only affects Massachusetts residents who have ASD and are enrolled in private health insurance plans. It applies to most private health insurance policies but does not apply to policyholders with MassHealth /CommonHealth. You should check with your individual insurance provider to verify the effect of the new law on coverage.
While this law is a huge victory for families who have loved ones with Autism, it does not diminish a school’s need to provide a free and appropriate public education. For example if a student now receives occupational therapy outside of school due to the reduced cost, but the IEP states that the student should receive occupational therapy during the school day to meet the student’s needs, the school cannot eliminate the therapy during school hours just because the student is now receiving therapy outside of school. The school must take into account what the student’s needs are in order to succeed in school and receive a free appropriate public education. The new law does not mandate reimbursement to schools and school districts for providing these services.
Hopefully the new law will lead to students receiving increased services outside of school allowing them to be more successful as they progress through their educations.