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ARICA: The Massachusetts Autism Insurance Law

This law requires insurance companies to cover services for autism diagnosis and treatment.

 

This includes many services:

  • Counseling services and treatment programs to develop, maintain, and restore functioning. This includes applied behavior analysis (ABA)

  • Pharmacy care: Prescribed medicines and health‐related services

  • Psychiatric care:Direct services or consultations from a psychiatrist

  • Psychological care: Direct services or consultations from a psychologist

  • Therapeutic care: Services from speech therapists, occupational therapists, physical therapists or social workers

  • Social skills groups

All services must be medically necessary and provided by licensed and certified professionals.

ARICA does apply to private insurers, employees and retirees under the state plan, and hospital service plans and HMOs. ARICA does NOT apply to self-funded plans - many large employers in Massachusetts use these plans. Check with your provider to see if they cover autism services outside of ARICA.

Find out if your plan is covered using the Autism Insurance Resource Center's Am I Covered? tool.

Read these for more info:

Use the Autism Insurance Research Center's Am I Covered? tool to see if your current insurance coverage follows ARICA. You can also call AIRC directly at 800-642-0249.

For help with co-pays for ABA therapy:

  • If ABA is covered by your Employer Sponsored or Qualified Health Plan, MassHealth will cover the co-pays through the Massachusetts Behavioral Health Partnership (MBHP)

  • Providers should call MBHP at 1-800-495-0086 for authorization - they do not have to go through MassHealth

 

Sources: Autism Insurance Resource Center at INDEX, The Arc of MA