New Health Insurance Benefit for Children with Autism

During the 2015 session of the Hawaii Legislature, a Bill was passed affecting children with a diagnosis of Autism spectrum disorder (ASD) under the age of 14 yrs. This law, known as “Luke’s Law,” mandates that all health insurance policies issued or renewed after January 1, 2016 provide coverage for the diagnosis and treatment of autism. Because this is a health insurance law, the diagnosis and treatment must be “medically necessary.”

The diagnosis of autism may involve assessments, evaluations, and tests.

The treatment of autism includes applied behavior analysis (ABA) necessary to develop, maintain or restore functioning. ABA may involve design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences to produce socially significant improvements in human behavior and includes direct observation, measurement and functional analysis of the relations between behavior and environment.

Treatment of autism (ABA) must be provided by a Autism Service Provider licensed by the State with a maximum benefit of $25,000 per year.

What does this mean to you and to Easter Seals Hawaii?
Easter Seals Hawaii Autism Center has been a provider of ABA services but funding for those services has been limited to private pay, Tricare (for military families) or, in some cases, support from the Department of Education. With this law, Easter Seals Hawaii is negotiating with five health insurance companies in Hawaii to become one of their providers, allowing families access to ABA services for their children with ASD. The Autism Services at Easter Seals will be growing as we recruit, train, and add qualified staff and expand services.

Anyone with health insurance coverage with questions about this benefit for their own child should contact the insurer. The benefit is required when the policy is issued or renewed and policies may renew at different times during the year.

We will do our best to keep you informed as this new law is implemented in 2016.

Jennifer Schember-Lang, VP Programs and Services

PS – for a background on “Luke’s Law” read this Civil Beat article from 2013.

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