Crisis Services
ASERT does not offer crisis services through our Resource Center. If you or someone you love is experiencing mental health distress or thoughts of suicide please call or text 988 for support.
ASERT does not offer crisis services through our Resource Center. If you or someone you love is experiencing mental health distress or thoughts of suicide please call or text 988 for support.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance, Medical Assistance (MA), or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62). ACT 62 is a statewide insurance mandate specific to services provided to children and adolescents with Autism Spectrum Disorder (ASD).
The Department of Human Services (DHS), Pennsylvania Insurance Department (PID), and Department of State (DOS) are working together to fully implement Act 62. A number of new resources have been developed to provide guidance to families about ACT 62.
The documents on this page provide important information and resources about the Autism Insurance Act, and new resources continue to be developed. We encourage you to visit this page regularly for the most up-to-date resources.
What to do if your child is enrolled in Medical Assistance and you have concerns about Applied Behavioral Analysis: If you are having a problem getting Applied Behavioral Analysis (“ABA” ) for your child that you have not been able to resolve with your Behavioral Health Managed Care Organization or the county, you may contact 717-772-7646 or ABA@pa.gov.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance or Medical Assistance (MA) under Pennsylvania’s Autism Insurance Act (ACT 62).
The Department of Human Services (DHS), Pennsylvania Insurance Department (PID), and Department of State (DOS) are working together to fully implement Act 62. The Departments worked together to identify the billing codes for providers to use to bill private insurance and MA for services to diagnose and treat ASD for children and adolescents. Beginning September 30, 2016, private insurance companies may approve services and claims that they may have denied in the past.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance, Medical Assistance (MA) or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62). ACT 62 is a statewide insurance mandate specific to services provided to children and adolescents with Autism Spectrum Disorder (ASD).
Children and adolescents under age 21 with ASD who:
*Act 62 does not apply to policies issued outside of PA or that are “self-funded” or “ERISA” policies.
Medically necessary services that are for the assessment and treatment of ASD, including:
Accessing autism services through private insurance results in significant cost savings to publicly-funded state programs.
The maximum amount private health insurance companies are required to pay as a result of Act 62 for the diagnostic assessment and treatment of ASD is known as the “cap.” The amount of the cap is adjusted annually. Coverage is subject to copayment, deductible, coinsurance, and
other exclusions or limitations to the same extent as other medical services covered by the policy. Some plans do not impose any cap. Be sure to check your plan.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance,
the Medical Assistance program (Medicaid) or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62).
Most private insurance plans are provided through an employer or purchased through the Health
Insurance Marketplace. Under the Affordable Care Act (ACA), individuals may be covered under their parent’s insurance until age 26.
Premiums: An insurance premium is the amount of money that an individual or business must pay for an insurance policy.
Copays: A copay (copayment) is a fixed amount you pay for covered services, typically when you receive the service.
Coinsurance: Coinsurance is the percentage of costs of a covered health care service that you pay after you’ve paid your deductible.
Deductibles: The amount you pay for covered health care services before your insurance plan starts to pay.
Out-of-Pocket Maximum: The most you have to pay for covered services in a plan year.
Provider Network: The doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its members.
Medicaid is the payer of last resort, meaning any other insurance coverage you may have should be billed first. You should always show your private insurance card, if you have private insurance, as well as your Medicaid card.
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.
Your child may qualify for Medicaid, better known as Medical Assistance (MA) in PA, if you meet income and other eligibility requirements.
Some children or adolescents (under age 18) may qualify on the basis of their disability, without regard to parental/guardian income or resources.
You may apply online using COMPASS. You can also contact your local county assistance office for an application or you may download an application from the Department of Human Services website to send to your county assistance office. If you need help completing the application form, trained county assistance staff members can help you.
For more information on qualifications, or to download an application visit: www.dhs.pa.gov
When children under age 18 have Medicaid and see a Medicaid participating provider, private
insurance costs such as copays, deductibles, and out-of-pocket maximums are not paid for by
the family. Certain Medicaid services provided to children ages 18-20 may be subject to a small MA copay amount.
Name | Description | Type | File |
---|---|---|---|
Act 62 | Information for Families | Download file: Act 62 | |
Act 62 | What is Act 62 | Download file: Act 62 | |
Act 62 | Differences Between Private Insurance and Medicaid | Download file: Act 62 |
This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.