Assigned to FIN FOR COMMITTEE
ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
FACT SHEET FOR S.B. 1590
mental health; autism; insurance coverage
Purpose
Removes the maximum insurance benefit cap on behavioral therapy for eligible persons
who are 16 years old or younger and updates the definition of autism spectrum disorder.
Background
The Department of Insurance and Financial Institutions regulates policies, certificates,
evidence of coverage and contracts of insurance that are issued or delivered by insurers. Insurers
include group disability insurers, blanket disability insurers, health care services organizations and
hospital or medical service corporations. Every insurer that offers individual health insurance
coverage in the individual market in Arizona must provide guaranteed availability of coverage to
eligible individuals who desire to enroll in individual health insurance coverage (A.R.S.
§ 20-1379).
Statute prohibits an insurer from: 1) excluding or denying coverage for a treatment or
impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of
autism spectrum disorder; or 2) excluding or denying coverage for medically necessary behavioral
therapy services. To be eligible for coverage, behavioral therapy services must be provided or
supervised by a licensed or certified provider. The outlined prohibitions do not prevent an insurer
from imposing deductibles, coinsurance or other cost sharing for the required coverage. Coverage
for behavioral therapy is subject to a: 1) $50,000 maximum benefit per year for an eligible person
up to 9 years old; or 2) $25,000 maximum benefit per year for an eligible person who is between
9 and 16 years old (A.R.S. §§ 20-826.04; 20-1057.11; 20-1402.03; and 20-1404.03).
In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was
published which introduced changes to the classification of autism spectrum disorder, including
removing diagnostic subcategories like Asperger's syndrome. Autism spectrum disorder is now
defined as persistent deficits in social communication and social interaction across multiple
contexts, as manifested by certain current or historical deficits (U.S. DHS IACC).
There is no anticipated fiscal impact to the state General Fund associated with this
legislation.
Provisions
1. Removes the maximum insurance benefit cap on behavioral therapy for eligible persons who
are 16 years old and younger. FACT SHEET
S.B. 1590
Page 2
2. Redefines autism spectrum disorder as a pervasive, developmental disorder that meets the
criteria for autism spectrum disorder in the most recent edition of the Diagnostic and Statistical
Manual of Mental Disorders.
3. Becomes effective on the general effective date.
Prepared by Senate Research
February 13, 2025
MG/ci