PA Autism Insurance Act (Act 62)
In Pennsylvania, your child's autism-related services may be covered by private health insurance, the Medical Assistance (MA) program, or the Children's Health Insurance Program (CHIP) under Pennsylvania's Autism Insurance Act (ACT 62). ACT 62 is a statewide insurance mandate specific to services provided to children and adolescents with Autism Spectrum Disorder (ASD).
The Department of Human Services, Pennsylvania Insurance Department and the Department of State are working together to successfully implement the Autism Insurance Act (ACT 62).
The documents on this page provide important information and resources about the Autism Insurance Act, and new resources continue to be developed. We encourage you to visit this page regularly for the most up-to-date resources.
What to do if your child is Enrolled in Medical Assistance and you have concerns about Applied Behavioral Analysis
If you are having a problem getting Applied Behavioral Analysis ("ABA") for your child that you have not been able to resolve with your Behavioral Health Managed Care Organization or the county, you may contact 717-772-7646 or ABA@pa.gov.
Pennsylvania Insurance Department-Consumer Services LinePennsylvania Insurance Department1209 Strawberry SquareHarrisburg, PA 17120Toll-free: 1-877-881-6388Fax: (717) 787-8585TTY/TDD: (717) 783-3898
The Department of Human Services has identified procedure codes that reflect services for the diagnostic assessment and treatment of Autism Spectrum Disorder (ASD) and may be subject to Act 62. Providers should confirm with the MA beneficiary's private health insurance which procedure codes are on their fee schedule, and check with the MA Program fee schedule or contact the appropriate MA MCOs to determine which procedure codes are on their fees schedules. The Department will continue to review procedure codes to identify additional codes that reflect services for the diagnostic assessment and treatment of ASD.
On August 25, 2016, the Department of Human Services and the Pennsylvania Insurance Department presented a webinar on changes impacting providers of child and adolescent autism services, as well as HealthChoices managed care organizations. The webinar included:
- Guidance for providers enrolled in the MA Program, both fee-for-service and HealthChoices, about the requirement to bill a child's or adolescent's private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD
- Clarification about the use of behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62
- A review of updated information and guidance for families that providers can duplicate and make available to families of children and adolescents with ASD
The recording of the webinar is available for review. The Power Point presentations for both the managed care and the service provider presentations are also now available.