Understanding the Puzzling Pieces of Autism

Iowa Autism Insurance Coverage

Iowa Current Law: effective January 1, 2011 “Drews Law”

The law requires the State Health Plan to cover diagnosis and treatment of autism spectrum disorder up to $36,000 a year for individuals less than 21 years old. Coverage includes medically necessary assessment, evaluations, or tests performed by certain licensed health providers to diagnose whether an individual has autism spectrum disorder, and treatment including:

  • Medically necessary pharmacy care
  • Psychiatric care
  • Psychological care
  • Rehabilitative care, including applied behavior analysisTherapeutic care that is either ordered or provided by a licensed health provider, or is provided by an autism service provider or a group or entity that works under an autism service provider.

The ABA therapy must be performed by an individual (or group of individuals) who are certified behavior analysts or State-licensed health professionals. Line therapists who are not certified or licensed will be covered by the law, so long as an “autism service provider” supervises the therapist.

Autism spectrum disorder does not have to be the primary diagnosis for the child in order to qualify for coverage.

Limits:

Private insurance is not included in the law, and, therefore, are not required to provide coverage for services for autism spectrum disorder.  This includes employer-based, large group plans, small group plans, individual plans.