Requires certain health benefits coverage for diagnosing and treating autism and other developmental disabilities.
If enacted, A636 will obligate various health insurance providers within New Jersey, including medical service corporations and health maintenance organizations, to ensure comprehensive coverage for individuals diagnosed with the specified conditions. Such coverage would involve medically necessary therapies, including occupational, physical, and speech therapy, with stipulations aimed at expediting access to treatment without the risk of denial based on the restorative nature of the therapy. This inclusion represents a significant step towards better support for those with autism and related disabilities, addressing historical gaps in service availability.
Assembly Bill A636 is an act that revises health benefits coverage requirements for diagnosing and treating autism and other developmental disabilities, including conditions like central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder. The bill amendments seek to align health insurance policies with updated definitions and coverage requirements based on recognized medical standards such as the DSM IV-TR and ICD classifications. Among the notable features, practitioners must adhere to these standards when diagnosing related conditions and insurers are tasked with maintaining coverage eligibility irrespective of updates in diagnostic criteria.
The proposed legislation does surface points of contention among stakeholders. Advocates for individuals with disabilities laud the changes, asserting that improved diagnostic standards and comprehensive coverage will mitigate the financial burden faced by families navigating these conditions. Conversely, some insurance groups may express concerns regarding the expansion of their financial responsibilities and potential implications for premiums and policy structuring. Discussions surrounding the balance between comprehensive care and the affordability of these services are expected as the bill moves through the legislative process.