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April 21, 2017

Autism Awareness

More than 3.5 million Americans live with autism spectrum disorder. As of 2010, the prevalence of autism diagnoses amongst children reached one in sixty-eight. April is Autism Awareness month, and New Mexico’s Office of the Superintendent of Insurance is leading the charge to raise awareness of how health insurance covers benefits related to autism spectrum disorder.

The State of New Mexico requires that all health insurance sold in the individual and small group markets to cover autism benefits. Autism spectrum disorder benefits are also a part of all state and municipal employees’ health insurance policies. Mandated benefits include cost-sharing free well-baby and well-child screenings for autism spectrum disorder, as well as coverage of speech therapy, occupational therapy, and physical therapy. All major medical coverage regulated under New Mexico law must also cover applied behavioral analysis. Additionally, health insurance may not deny access to treatment programs that are necessary to develop, maintain, and restore the life skills and functions of individuals diagnosed with autism spectrum disorder.

The Affordable Care Act removed age-restrictions, dollar-restrictions, and lifetime benefit limits for autism treatment benefits. The ACA also provides additional protections for treatment of autism spectrum disorder through broader application of federal mental health parity law to individual and small group health plans. Federal mental health parity law requires that health insurers provide mental and behavioral health benefits with no more restrictions than medical surgical benefits. As a result, access to services for autism spectrum disorder may not be limited in any way that is more restrictive than access to analogous medical or surgical benefits.

OSI urges individuals and families impacted by autism spectrum disorder to explore your insurance coverage to discover what your health insurance provides. If you have trouble accessing your insurance’s autism spectrum disorder benefits, the Office of the Superintendent of Insurance is here to help! Consumers can receive assistance with questions or issues accessing care through their health insurance plan or health insurance billing issues by filing inquiries and complaints with OSI’s Managed Health Care Bureau by calling 1-855-4-ASK-OSI or completing the online complaint form online at http://www.osi.state.nm.us.


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