What are the Missouri Insurance Mandates for Aba Therapy Coverage?
Missouri state law mandates that fully insured group and individual health plans must provide coverage for the diagnosis and treatment of autism spectrum disorders (ASD), including Applied Behavior Analysis (ABA) therapy. This mandate applies to state-regulated plans governed by the Missouri Department of Insurance. For a child to access this coverage, they typically need a formal ASD diagnosis, a treatment plan based on medical necessity, and supervision by a Board Certified Behavior Analyst or a similarly licensed professional.
Key details regarding these mandates include:
- Age and Benefit Limits: As of 2025, the mandated annual benefit cap is $40,000 for children through age 18. Generally, mandated coverage is available for children up to age 21.
- Plan Types: The mandate specifically applies to fully insured plans. Self-funded or ERISA plans are governed by federal law and are not legally bound by Missouri state autism insurance requirements; therefore, coverage for these plans is at the employer’s discretion.
- Medicaid: MO HealthNet (Medicaid) covers medically necessary ABA therapy for eligible children under 21 through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
- Additional Requirements: Even with mandated coverage, insurers may still require preauthorization, ongoing progress reports, and reauthorizations for continued sessions.
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