ARICA

What does ARICA do?
ARICA requires health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder, which currently affects 1 in every 54 individuals.

What types of policies does ARICA cover?
Massachusetts legislation can only affect certain types of health care policies, so coverage under ARICA will depend on the type of policy you have. Private insurers, employees and retirees under the state plan, hospital service plans and HMOs would all be required to comply with the mandate. Self-funded plans are regulated by ERISA – which is federal law. This includes many of the State’s largest employers. ERISA plans are not subject to State laws and not required to provide coverage under ARICA.

How can I find out if I have coverage under ARICA?
Contact your employer to verify that your policy is subject to the new law, and if so, what annual date your group policy renews. Even if your company is regulated by ERISA, they may as practice comply with State laws. In addition, there is language in the recently enacted federal health care reform that will eventually cover autism treatment. If you are covered by an ERISA plan, please contact us for additional information and assistance in advocating for coverage with your company.

Are individuals or family members covered for services under MassHealth
or CommonHealth?

These programs are not subject to the new law, but consumers should know the following:

MassHealth will cover co-pays and deductibles for ARICA mandated treatment covered by private insurance.

The Premium Assistance Program can help subsidize purchase of private insurance policies and policies through Commonwealth Choice that will cover ARICA. Note- Commonwealth Choice has an enrollment window of July 1-August 15, 2011.

Families covered by MassHealth or CommonHealth with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through DDS. Note – this is a limited program with specific application windows, check with DDS for more information.

In certain cases, consumers may be able to access some treatments through EPSDT.

Is there a limit to the amount of coverage?
These programs are not subject to the new law, but consumers should know the following:

MassHealth will cover co-pays and deductibles for ARICA mandated treatment covered by private insurance.

The Premium Assistance Program can help subsidize purchase of private insurance policies and policies through Commonwealth Choice that will cover ARICA. Note- Commonwealth Choice has an enrollment window of July 1-August 15, 2011.

Families covered by MassHealth or CommonHealth with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through DDS. Note – this is a limited program with specific application windows, check with DDS for more information.

In certain cases, consumers may be able to access some treatments through EPSDT.

Is there an age limit to this coverage?
There is no age limit.

What treatments are covered under ARICA?
These programs are not subject to the new law, but consumers should know the following:

MassHealth will cover co-pays and deductibles for ARICA mandated treatment covered by private insurance.

The Premium Assistance Program can help subsidize purchase of private insurance policies and policies through Commonwealth Choice that will cover ARICA. Note- Commonwealth Choice has an enrollment window of July 1-August 15, 2011.

Families covered by MassHealth or CommonHealth with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through DDS. Note – this is a limited program with specific application windows, check with DDS for more information.

In certain cases, consumers may be able to access some treatments through EPSDT.

Are Social Skills Groups Covered?
Yes, per the parameters of the covered treatments described above.

How are educational services affected?
ARICA does not affect educational services provided under an IFSP, IEP or ISP. Insurers are not required to pay for in-school services. Conversely, under IDEA, schools may not require parents to access private insurance for services that are part of FAPE.

*All information on this page was obtained from the Autism Insurance Resource Center at http://www.disabilityinfo.org/ARICA/aricafaqs.aspx

Autism Behavioral Services offers insurance funded Applied Behavior Analysis (ABA) in central Massachusetts & Greater Boston.

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