NJ Health Insurers Now Required To Cover Autism Treatment

TRENTON – New Jersey health insurers are now required to provide coverage for screening for autism and other developmental disabilities as well as any medically-necessary occupational, physical and speech therapy, under a new law signed last week by Gov. Corzine.

“If a treatment or therapy exists which can make life easier for autistic children or the developmentally disabled and their caregivers, insurance companies have a sacred responsibility to provide access to that treatment,” said Sen. Joseph Vitale, D-Middlesex, and chairman of the Senate Health, Human Services and Senior Citizens Committee.


“Researchers on the cutting edge of their fields are discovering new things about autism spectrum disorders and developmental disabilities every day.  We need to put the latest proven therapies within reach of those families who will see the greatest benefit, and we need to give autistic kids and the developmentally disabled a chance to achieve their maximum potential,” Vitale said.

The measure requires that insurers in New Jersey would be required to provide insurance coverage for diagnostic and therapeutic services designed to identify and treat autism and other developmental disabilities.  Under the bill, insurance companies will be required to provide up to $36,000 per year in coverage for medically necessary behavioral early intervention for all autistic patients under 21 years old.  Beginning Jan. 1, 2012, the Department of Banking and Insurance will adjust the maximum benefit to reflect inflation according to the consumer price index.

The sponsors noted that research has demonstrated that early intervention services, which include speech, physical and occupational therapy, help the majority of young children with autism and other developmental disabilities to learn important skills.  Additionally, numerous studies have shown that early treatment of autism spectrum disorders through behavioral intervention may serve to mitigate many of the problems and challenges associated with the disorder.

New Jersey becomes the eleventh state nationwide to have enacted some form of legislation requiring insurance coverage of autism treatment.  Most have some form of cap on expenses paid out by insurers – ranging from $36,000 to $50,000 – and most cap the age limit at which insurers must cover treatment – ranging from 6 years old to 21 years old.

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