MICHIGAN AUTISM INSURANCE LEGISLATION

Michigan’s Autism Insurance Reform legislation (PA 99 and PA 100 of 2012) went into effect on October 15, 2012.

For-profit, commercial, HMO, and non-profit health insurance companies regulated by the state of Michigan are mandated to provide an autism benefit to its insured members covering services related to the diagnosis and treatment of autism spectrum disorder through 26 years of age.

Self-funded insurance plans are regulated by the Employee Retirement Income Security Act, commonly referred to as ERISA through federal law.

Self-funded insurance plans are not mandated to provide autism coverage. However, if a self-insured company self-adopts an autism benefit whereby employees are offered autism coverage by the self-insured plan, then the self-insured company either directly or through its third-party administrator (TPA) may submit reimbursement request(s) to cover the cost of the paid claims to the Autism Coverage Fund.

The Autism Coverage Fund was created to offset the cost of providing an autism benefit for health insurers, TPAs, and self-insured companies.

To participate in the Fund, paid claims must be for insured members who are residents of Michigan and who receive an autism spectrum disorder diagnosis and treatment by Michigan providers.

Medicaid
& MIChild Autism Benefit

The Michigan Medicaid and MIChild Autism Benefit went into effect on April 1, 2013.This Autism Benefit provides children ages 18 months through 21 years old who have a medical diagnosis of autism spectrum disorder (ASD) with Applied Behavior Analysis (ABA) services. ABA is a recommended service for children with autism spectrum disorder. It has been researched for over 30 years and endorsed by the US Surgeon General. ABA treatment can be used to address skills and behaviors relevant to children with autism spectrum disorder.

Insurance Verification
& Billing

You must provide proof of insurance prior to your first visit. ACM works with and bills your insurance as a courtesy to you. Our intake staff will verify benefits and discuss with you your coverage benefits and expectations for payment of deductibles, co-payment, and co-insurance costs. It is your responsibility to know what your insurance coverage is and to track your visits. You are responsible for any payment of services that is not covered by your insurance. If your insurance does not cover a service you may have the option to pay privately. ACM will not change billing codes in an effort to receive payment for services that we have knowledge will not be covered otherwise.

We're here for you.

The Autism Centers of Michigan is Michigan’s leading provider of intensive, evidence-based applied behavior analysis treatment.