The Shapiro Administration will direct health insurance companies to provide coverage for autism benefits starting January 1, 2024 in accordance with the Mental Health Parity Act, making autism benefits available to tens of thousands of Pennsylvanians with autism. Measures have been taken to ensure that equality is achieved.
Harrisburg, Pennsylvania – today, Governor Josh Shapiro and the Pennsylvania Insurance Department (PID). Commissioner Michael Humphries The Shapiro administration announced that starting January 1, 2024, all private insurance companies will be required to meet their obligations under Pennsylvania law to provide coverage for autism benefits.
PID Notice issued In the Pennsylvania Gazette dated November 4, 2023, PID requires that by January 1, 2024, insurance companies offering commercial health insurance that include coverage for autism services must provide coverage for autism services in a manner consistent with the Mental Health Act. announced that it would be mandatory to process claims for services. Parity and Addiction Equity Act of 2008 (MHPAEA) and Pennsylvania’s Mental Health Parity Requirements.
“Today, my administration is making clear that autism services are mental health services with full parity protections, and that insurance companies will ensure that they are treated consistently and equitably under the Mental Health Parity Act. I look forward to covering it.” Governor Josh Shapiro. “With today’s announcement, we are removing unnecessary barriers to care for more than 55,000 Pennsylvanians with autism and ensuring they have the treatment they need to live happy and productive lives. I support you. My administration is deeply committed to improving access to care for Pennsylvanians, and it is.”Common sense solutions that allow us to continue to make real progress and give families peace of mind. We hope that we will come together to provide. ”
The Shapiro Administration is working to make mental health equity a real reality in Pennsylvania. Part of making this a reality includes requiring commercial insurers to comply with all mental health equity laws to ensure they cover autism services fairly and consistently. With this measure, the Shapiro administration will require these insurers to fully comply with equivalence requirements in their autism insurance coverage. This means recognizing that autism services are a mental health benefit.
Some private insurance companies have historically classified autism services as a physical health benefit, while other insurance companies have classified all services for autism as a mental health benefit. Most major health insurance companies offering comprehensive health insurance in Pennsylvania already treat autism as a mental health condition and meet equivalency requirements. The PID notice also directs the remaining insurance companies to take similar steps.
in him first budget speech, Governor Shapiro called for greater mental health equity and directed Secretary Humphries and the PID to hold insurance companies accountable to ensure that mental health benefits are equitably covered. As a result, PID announced Mental Health and Substance Use Disorders to strengthen review of mental health and substance use disorder coverage in the 2024 Health Plan and prevent potential violations before they can harm Pennsylvania consumers. The government said it would strengthen its compliance review of equivalent requirements.
“We are working to ensure that insurers, where appropriate, are expediting health insurance contract language and claims processing processes to provide Pennsylvania’s autistic consumers with the protections afforded by mental health parity provisions.” I hope that it will be adjusted accordingly.” Pennsylvania Insurance Commissioner Michael Humphries. “We are sharing this message with the entire autism community. If you have been denied access to services or encountered unreasonable coverage limitations, we encourage you to contact us. The Shapiro Administration will support you and work with you and your insurance company to help you avoid mental health equity violations and live a healthy, productive life.”
Classifying autism as a mental health benefit would force health insurance companies to adjust policy language and claims processing processes to provide Pennsylvanians with autism with the protections afforded by mental health parity provisions. Requiring this will have a positive impact on the approximately 55,000 Pennsylvanians with autism. As a result, health insurance companies will not be able to: Charging higher copays and deductibles for autism services than physical health services, covering more visits for autism services than for other health conditions, and imposing annual limits on autism services. or other safeguards. Under state and federal equality laws.
“Equivalent coverage of autism-related care and other services has been a long-standing goal of the disability community,” he said. Rep. Jessica Benham. “We thank Governor Shapiro and his administration for prioritizing this change. This is a step in the right direction to ensure greater access to care for people with developmental disabilities.”
drexel university AJ Drexel Autism Institute is a federal partner assert (Autism Services, Education, Resources and Training) Collaborative. Funded by the Pennsylvania Department of Human Services Office of Autism and Special Population Services. ASERT Collaborative’s mission is to innovate, collaborate, and lead to improved access to quality services, data, and information. Provide support, training and education on best practices. and to foster connections between individuals with autism and developmental disabilities and special populations, families, and key stakeholders at the local, state, and national levels.
“Today, we are all gathered here to celebrate a significant milestone in Pennsylvania Mental Health Equity for People with Autism. Mental Health Equity means that insurance plans include mental health and autism services, “It means providing fair compensation and financial support for substance use disorder services.” Dr. Diana Robbins, Director and Professor, AJ Drexel Autism Research Institute. “I would like to thank Governor Shapiro and his administration, including the Department of Human Services and the Department of Health Services, for their continued support and work with Pennsylvanians with autism and intellectual and developmental disabilities.”
Eagles Autism Foundation Executive Director ryan hammond The Shapiro administration and the AJ Drexel Autism Institute also participated in the announcement. Eagles Autism Foundation helps fund groundbreaking research, drive scientific advances and provide critical resources to create major changes from awareness to behavior in the autism community doing.
“The Eagles Autism Foundation is proud to support the efforts of Governor Shapiro and key stakeholders to ensure people diagnosed with autism have access to much-needed services.” Stated. Ryan Hammond, Eagles Autism Foundation Executive Director. “We know that intervention and support are key to changing the trajectory and outcome of a person’s life, and we believe that through this policy families’ needs will be better met and lives changed as a result. We recognize that we all need to: Advance our collective mission of helping people live their best lives, and ensure that today’s events help us continue into the future. It’s a great example of what can be done.”
PID states that treating autism as a mental health condition is consistent with the standards of the Diagnostic and Statistical Manual of Mental Disorders (DSM) that were in effect at the time of enactment of State and Federal Law No. 62 of 2008. thinking about. MHPAEA as well as generally recognized independent standards for current medical practice, including both the current edition of the DSM and the current edition of the DSM. international classification of diseases, as permitted by the definition of “mental health benefits” in the Federal Mental Health Equivalency Regulations. The DSM is an authoritative source of information under Section 62 of the Pennsylvania Autism Act.
Pennsylvania law requires certain group insurance policies or contracts to cover diagnostic evaluation and treatment for autism spectrum disorders. Through the Affordable Care Act, this law also applies to individual and small group insurance. The department monitors coverage of autism services, including whether autism services are covered as a mental health condition under the federal MHPAEA law, which was adopted as state law in 2010.
For assistance with insurance companies, Pennsylvanians can contact PID’s Bureau of Consumer Services. online or 1-877-881-6388. To learn more about the Shapiro Administration’s efforts to support Pennsylvanians with autism, visit pa.gov/autism.
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