Learn more about who’s covered and all available options.
NYS Insurance Law and Coverage
Q: Why are these services now available?
A: In late 2012, a law took effect in New York State requiring certain health insurance plans to cover services for individuals on the autism spectrum.
Q: What services are covered under the insurance law?
A: Covered plans are required to provide medically necessary coverage for the screening, diagnosis, and treatment of autism spectrum disorders, including: *Behavioral health treatment (such as applied behavioral analysis: ABA), Therapeutic care provided by licensed or certified speech therapists, physical therapists, occupational therapists, or social workers, Pharmacy care (if the policy covers other prescription drugs), Psychiatric care, *Psychological care, Augmentative communication devices, Any other medical care provided by a licensed health care provider; *- Currently provided by ABI
Q: Who is eligible?
A: To be eligible for insurance coverage for these services, individuals must have a diagnosed autism spectrum disorder (ASD) and a plan covered by the autism insurance reform law.
Q: Are there any limits to the law?
A: There are no age limits as a diagnosed individual of any age may qualify. Plans covered by the reform law must provide coverage up to $45,000 per year, and that limit will increase annually.
Q: Which health plans are required to pay for these services?
A: Plans that must cover these services include: Child Health Plus plans, plans covering government employees, and fully-insured commercial health plans. Plans not required to cover these services include Medicaid plans and self-insured plans. Although not mandated, some self-insured plans may choose to cover these services.
A: ABI can help you determine what your plan will cover.
Q: If I am interested but my insurance plan doesn’t cover these services, what alternatives do I have?
A: Several options are available to people whose plan does not cover ABA and other services. ABI can provide these services on a private, or out-of-pocket, basis. Alternatively, your child may be eligible for a Child Health Plus plan with coverage. If you are interested, we can send you information about enrolling in one of these plans.
Q: If I change insurances, will I or my child still be able to see my physician?
A: This is an important consideration, especially for individuals with autism spectrum disorders. You should ask your physicians, your other healthcare providers, and their office staff what other insurances they accept before deciding to change insurance plans.
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Nature of Services Through ABI
Q: How many hours of service can be expected?
A: Levels of service vary from case to case. ABI will conduct an assessment and can also help you determine what your plan covers in order to develop a tailored care plan.
Q: What will I need to pay?
A: Your plan will most likely have deductibles, co-pays, and/or co-insurance that you will be responsible for. ABI can help you determine what your family’s obligations will be and can assist you in financial planning, if needed.
Q: When and where will services be provided?
A: Services are generally provided in the home and community, though evaluations/assessments may occur in an office setting. School is not typically an insurance approved setting.
A: Services typically occur in the afternoons, evenings, and/or weekends, though daytime can be made available as needed.
Q: Do you have bi-lingual home evaluators and therapists?
A: Yes. Our evaluators and therapists speak many languages.
Q: Will my child get a school record as a result of participation?
A: No. These services are provided outside of the school system.
Q: Can services be provided to a child already receiving early intervention (EI) or CPSE services?
A: Qualifying insurance plans are required to provide these services when they are clinically appropriate, even in addition to an IFSP. When a child is receiving ABA through an early intervention program, families generally wait until after the child leaves the program before accessing services directly through the insurance plan.
Q: Is this a respite service?
A: No. It is a therapeutic service that works closely with family members to transfer skills; A caregiver must be present during sessions
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Gain a deeper understanding of the ABA Therapeutic Technique.
ABA Therapy
Q: What is ABA?
A: Applied Behavior Analysis (ABA) is a therapeutic technique that utilizes the scientific principles of learning to change behavior. Positive reinforcement is one such principle. When a behavior is rewarded, that behavior is more likely to be repeated. The field of behavior analysis has developed many techniques to increase useful behaviors and to reduce those that are problematic or that interfere with learning.
Q: Who provides ABA services?
A: ABA therapy is typically implemented by a qualified, extensively trained paraprofessional, with some exceptions for treatment by an LMSW or Special Educator in certain cases; All staff are required to meet education and/or experience based state standards.
A: Supervision is provided by a NYS licensed Board Certified Behavior Specialist (BCBA) in most cases or by a licensed individual in a similar field (e.g., Social Work, Mental Health); State standards require a high level of direct and indirect supervision to ABA therapists providing direct support.
A: All cases and programs are overseen by an experienced BCBA Program Supervisor.
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