Act No. 127

(S.262)

Health; health insurance; autism spectrum disorders

This act requires health insurance plans, including private insurance, Medicaid, and the Vermont health access plan, to provide coverage for the diagnosis and treatment of autism spectrum disorders for children starting at 18 months of age and continuing until they reach age six or enter the first grade, whichever occurs first. It prohibits a plan from limiting the number of visits a covered child may have with an autism services provider or from imposing greater cost-sharing requirements for coverage of autism spectrum disorders than apply to any other physical or mental health condition under the plan.

The act directs the agencies of administration and of human services and the department of education to evaluate the feasibility and budget impacts of expanding the coverage mandate to include all children under the age of 18 who have been diagnosed with an autism spectrum disorder. It also requires them to assess the availability of providers of services across Vermont for individuals with autism spectrum disorders and to report to the committees of jurisdiction on both of these issues by January 15, 2011.

The act directs the agencies and the department to work together in preparing their fiscal year 2012 budget proposals to identify savings, reductions in spending trends, and avoided costs to be achieved by reducing duplications of effort and maximizing efficiencies in the provision of services to children with autism spectrum disorders and to report these findings to the committees of jurisdiction by February 15, 2011. They must estimate the amount of savings and avoided costs to be realized by the state as a result of the coverage mandate, collaborate with the joint fiscal office, and include in their fiscal year 2012 budget proposals projected offsets for the state's share of expenditures resulting from the mandate. If the report or the findings of the committees of jurisdiction indicate there will not be sufficient funds to offset the state's share of expenditures, the act expresses the legislature's intent to consider whether or not to allow the coverage mandate to be imp lemented.

Date Signed by the Governor:  May 27, 2010

Effective Date:  On passage (May 27, 2010, the date on which the governor signed the bill), except that the coverage mandate takes effect July 1, 2011, and applies to all health insurance plans on and after July 1, 2011, on such date as a health insurer offers, issues, or renews the health insurance plan, but in no event later than July 1, 2012.