On April 19, 2022, Insurance Commissioner White released Administrative Letter 2022-2 related to coverage of autism spectrum disorder (ASD). After discussions with CMS and research, the Virginia Bureau of Insurance has revised its position on ASD and related insurance coverage. Policies issued on or after January 1, 2023, must classify ASD as a mental health disorder. Coverage under any group medical policy must provide for the treatment of ASD, including medically necessary behavioral health treatment, pharmacy care, psychiatric care, psychological care and therapeutic care. Coverage must specifically include applied behavioral analysis (ABA) services. The Bureau will consider any ABA exclusion to be a violation of both Virginia law and the Mental Health Parity and Addiction Equity Act. There is an exception for grandfathered small group health insurance coverage, which is not subject to MHPAEA requirements.
Further, treatment of ASD, including ABA services, will be considered an essential health benefit under Virginia’s benchmark plan. Thus, insured policies and self-insured plans that identify Virginia as their benchmark plan will be prohibited from excluding or placing dollar limits on such coverage.
Administrative Letter 2022-2 »
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