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The Law and Autism Services


Autism Legislation in Massachusetts

The new autism legislation in Massachusetts is called ARICA An Act Relative to Insurance Coverage for Autism. It is very good news for individuals with autism spectrum disorder (ASD) and their families. It gives them increased access to treatments that offer the greatest likelihood of positive life outcomes: ABA and other evidence-based therapies.

What is ARICA?
ARICA is “An Act Relative to Insurance Coverage for Autism.” It went into effect in Massachusetts on January 1, 2011. Massachusetts is one of 24 states that have recently enacted such legislation. This new law requires that insured health plans cover “medically necessary” services for the diagnosis and treatment of autism spectrum disorders (ASD) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR).

Who can obtain services?
Children or adults of any age with a diagnosis of Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorders Not Otherwise Specified (PPD-NOS) who have a medical need for services.

What services are covered by the ARICA law?
According to the Massachusetts Division of Insurance (DOI), insured health plans must now cover evidence-based, medically necessary autism services that are prescribed, provided, or ordered by a licensed physician or licensed psychologist.

  • Companies with self-funded insurance plans are not required to provide this coverage. You may, however, ask your company to provide this coverage.
  • Mass Health is not covered under the ARICA law; however, Massachusetts has a premium assistance program that allows Mass Health families to access private insurance.

Which insured health plans are covered by the new law?
Participating health plans include Blue Cross, United Behavioral Health (UBH), Celtic Care, Tufts, and all private insurances.

Are there limitations on services covered by this new legislation?
The new law requires insured health plans to cover the diagnosis and treatment of ASD in exactly the same way they cover the diagnosis and treatment of physical conditions. This includes any annual or lifetime limitations imposed on dollars spent or visits covered. The law also makes it clear that there are no age restrictions for individuals in need of services.

How do I access services?
This varies by insurance company. Contact us for assistance in obtaining services or for more information about ARICA.




  
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