Ava’s Law, named for Ava Bullard of Lyons, GA, whose early autism treatment helped to restore her speech, kept close watch as Governor Nathan Deal signed Georgia’s Autism bill into law on April 29th 2015.
What Does this bill mean for Georgia Families?
Here’s how we interpret Georgia Constitution House Bill 429 (aka Ava’s Law) for meaningful autism insurance legislation, line by line. This law applies to state funded insurance programs — not federal or self-funded. Use the Autism Speaks (blue) link below to determine which type of plan your family has.
- Children under the age of 6 who have been diagnosed with autism (or other terminal conditions) are guaranteed $30,000 of insurance coverage per year towards treatment specifically for autism spectrum disorders.
- Insurance coverage includes treatments of commonly used interventions for autism spectrum disorders, such as physical therapy (PT), occupational therapy (OT), applied behavior analysis (ABA), speech-language therapy (ST), and marriage and family therapy. Line 78
- Assessments, evaluations, or tests are covered when performed by a licensed physician or psychologist, if determining the presence of an autism spectrum disorder. Line 91
- Insurance companies are required to provide coverage when it is deemed medically necessary (ordered/prescribed) by a licensed medical doctor or psychologist. Line 94
- An insurer may request documentation of medical necessity, at least annually. Line 94
- There are no limits to the number of therapy visits, except ABA. Line 100
- Government insurers (i.e. Medicaid) are exempt from providing coverage for behavioral health (i.e. counseling). Line 118
- Coverage begins following the next renewal period of your specific insurance policy. Line 142
- The insurer cannot apply payments for un-related autism spectrum disorders to the allotted $30K of coverage for ABA. Treatment visits for ST, OT, PT, due to sickness, contract policy, or benefit plan cannot be limited by the new autism code. Line 164
- Though this law currently covers some children now, in 2016, a tax of 0.2% will be proposed to raise $300M to cover treatments for children up to 18 years old (HR 808). Line 201
- Once HR 808 is ratified, inclusion of children older than 6 will occur. Changes would result in coverage for all children with autism spectrum disorders by expanding the definition and requiring insurers who cover any neurological disorder to include autism spectrum. Section 2B