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PA Bulletin, Doc. No. 23-1534

NOTICES

INSURANCE DEPARTMENT

Autism Spectrum Disorders Coverage and Parity; Notice 2023-16

[53 Pa.B. 6983]
[Saturday, November 4, 2023]

 This notice is issued to advise all entities who provide health insurance and are subject to section 635.2 of The Insurance Company Law of 1921 (added by section 2 of Act 62 of 2008) (Act 62) (40 P.S. § 764h) of their obligations under Commonwealth law in the provision of health insurance policy coverage for autism benefits. Section 635.2 of The Insurance Company Law of 1921 requires coverage of the diagnostic assessment and treatment of autism spectrum disorders by certain group insurance policies or contracts. The Insurance Department (Department) has monitored the provision of autism services, including whether they have been covered as a mental health condition subject to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) (42 U.S.C. § 300gg-26), adopted into State law by the act of March 22, 2010 (Pub.L. 147, No. 14) (Act 14) (40 P.S. §§ 908-11—908-16), which amended The Insurance Company Law of 1921 to add Article VI-B.

 The Department is of the view that treating autism as a mental health condition is consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM) in effect at the time of enactment of Act 62, MHPAEA and Act 14, as well as ''generally recognized independent standards of current medical practice,'' including both the current edition of the DSM and the current edition of the International Classification of Diseases, as specified in the Federal mental health parity regulatory definition of ''mental health benefits,'' 45 CFR 146.136(a) (relating to parity in mental health and substance use disorder benefits). See also Requirements Related to the Mental Health Parity and Addiction Equity Act, 88 FR 51552 (August 3, 2023) (to be codified at, inter alia, 45 CFR Parts 146 and 147 (relating to requirements for the group health insurance market; and health insurance reform requirements for the group and individual health insurance markets)). The DSM is the authoritative source under the Commonwealth's autism law in section 635.2(f)(3) of The Insurance Company Law of 1921.

 Most of the major health insurers offering comprehensive health insurance in this Commonwealth already treat autism as a mental health condition, subject to parity requirements. The Department expects that any insurer not currently doing so will be able to promptly adjust its health insurance policy form language and claims handling processes to provide consumers in this Commonwealth with autism with the protections afforded by the mental health parity provisions. The Department anticipates that by no later than January 1, 2024, all insurers offering health insurance policies that include coverage for autism services will handle claims for those services in a manner that complies with MHPAEA.

 Questions regarding this notice may be directed to the Bureau of Life, Accident and Health, Insurance Department, 1311 Strawberry Square, Harrisburg, PA 17120, ra-rateform@pa.gov.

MICHAEL HUMPHREYS, 
Insurance Commissioner

[Pa.B. Doc. No. 23-1534. Filed for public inspection November 3, 2023, 9:00 a.m.]


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