ABA as Named Treatment Under Michigan’s Autism Law
Michigan’s insurance statutes do not leave ABA to inference. They define it, and they place it inside a list of treatments an insured plan must cover.
What the statute says about ABA
The definition
The statute defines applied behavior analysis as the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce significant improvement in human behavior, including direct observation, measurement and functional analysis.
Where it sits
ABA falls under behavioral health treatment, one of five kinds of care that make up treatment of autism spectrum disorders. The others are pharmacy care, psychiatric care, psychological care and therapeutic care.
Medical necessity still applies
Covered treatment is evidence-based care prescribed or ordered by a licensed physician or licensed psychologist who determines it is medically necessary. A plan can review that necessity.
Which diagnoses count
The statute lists autistic disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified, as the diagnostic manual defines them.
Back to the ABA guide.
ABA as Named Treatment Under Michigan’s Autism Law: short answers
Is ABA specifically named in the Michigan mandate?
Yes. Section 3406s of the Insurance Code and section 416e of the Nonprofit Health Care Corporation Reform Act both define behavioral health treatment to include applied behavior analysis.
Does the mandate cover only ABA?
No. It also covers pharmacy care, psychiatric care, psychological care and therapeutic care such as speech, occupational and physical therapy, subject to the plan’s terms.
Who decides ABA is medically necessary?
A licensed physician or licensed psychologist must prescribe or order the care and determine it is medically necessary. The insurer may then review medical necessity under its utilization review rules.
ABA as Named Treatment Under Michigan’s Autism Law: not legal advice. Send us your renewal.
Where these details come from
The laws and rules named on this page link to the official text. This is general information, not legal advice, and rules change, so check the current text.
MCL 500.3406s, Insurance Code of 1956
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