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THE AUTISM INSURANCE RESOURCE CENTER:
Provides information about coverage under the Act Relative to Insurance Coverage for Autism (ARICA). If you have questions about medicaid, the law or why your insurance plan does not cover ABA services, please contact the Autism Insurance Resource Center.
For information about insurance legislation across the nation and other helpful resources for families and children with autism, visit www.autismspeaks.org.
WE ARE IN NETWORK WITH THE FOLLOWING INSURANCE PLANS:
- Beacon Health Strategies – GIC
- Blue Cross Blue Shield of Mass
- Boston Medical Center (BMC)
- Fallon Health
- United Behavioral Health
- If your plan is not listed, please contact us, we still may be able to provide services.
Eligibility: To be eligible for services provided under the ARICA bill, your child must meet the following criteria:
- Have a diagnosis on the Autism spectrum, supported by a diagnostic report
- Meet medical necessity criteria, supported by a letter from a licensed clinician deeming ABA services medically necessary
Note: If you have a self-insured plan, ABA services may or may not be covered. You can call the number on your insurance card to find out this information.
IF YOU ARE NOT SURE WHETHER OR NOT YOUR CHILD IS ELIGIBLE, FOLLOW THESE STEPS:
- Call the number on the back of your insurance card. Ask if you are eligible for ABA services to be covered.
- If you are covered, find out what your deductible and co-pays are for this service, and whether or not you have a yearly maximum.
- Make sure you have proof of your child’s diagnosis on the autism spectrum and proof that ABA services are medically necessary. This proof can be in the form of a letter from a licensed physician (your child’s PCP for example) or a licensed psychologist. It could also be in the form of an evaluation from a licensed physician or psychologist.
- If you are NOT covered because your insurance plan is self-funded and your employer has opted out of the benefit, see Insurance Information and Resources to learn what steps you can take.
MBHP‐In Home Behavioral Services
We accept Massachusetts Behavioral Health Partnership (MBHP) through Mass Health and the Children’s Behavioral Health Initiative (CBHI). CBHI is an interagency initiative from MassHealth whose mission is to ensure that families and their children with significant behavioral, emotional, and mental health needs obtain the services necessary for success in the home, school, and community. In-Home Behavioral Services (IHBS) is one of several different services offered under the Children’s Behavioral Health Initiative.
IHBS IS AVAILABLE THROUGH AGE 21
Eligibility: In order for Advances to provide IHBS, your child must have either a diagnosis on the autism spectrum or a mental health diagnosis. Your child must also meet medical necessity criteria:
Is the youth displaying severe behavior problems?
Is the youth experiencing persistent behavior problems?
Has the youth been unable to benefit from talk therapy (if appropriate)?
Have less intensive treatment approaches been attempted? Is a more intensive approach also needed?
The Act Relative to Insurance Coverage for Autism (ARICA) went into effect January 1, 2011 and requires private health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorders. ARICA includes Applied Behavior Analysis services, supervised by a Board Certified Behavior Analyst. Covered ABA services include In-home ABA consultation as well as our on-site Social Skills Groups and Summer Services.
Insurance companies subject to ARICA include private insurance, the state plan (for employees and retirees), hospital service plans, and HMOs. Self-funded plans must follow federal law and are not subject to ARICA.
ARICA does not impact how services are delivered through a child’s IEP. The Individuals with Disabilities Education Act (IDEA) is still in effect. Insurance services are based on medical necessity and can be provided in addition to services provided by the school.