Insurance: health insurers; required coverage for autism spectrum disorders; modify. Amends sec. 3406s of 1956 PA 218 (MCL 500.3406s).
House Bill 4740 would amend Michigan’s Insurance Code to revise the state’s autism insurance coverage mandate for health insurance policies delivered, issued, or renewed in Michigan. The bill requires coverage for the diagnosis and treatment of autism spectrum disorders and prohibits insurers from denying, terminating, or limiting coverage solely because an individual has an autism diagnosis or has received autism treatment. It also bars insurers from imposing visit caps or treating autism services as merely educational or habilitative for purposes of denial.
The bill preserves a framework of age-based annual benefit limits for autism treatment: up to $50,000 for children through age 6, $40,000 for ages 7 through 12, and $30,000 for ages 13 through 18, with coverage limited to individuals through age 18. It defines covered services broadly to include behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care, and it allows insurers to require treatment plans, periodic diagnostic review, and annual developmental evaluations. The bill also clarifies that it does not expand coverage beyond federal essential health benefits for qualified health plans, does not apply to short-term limited-duration policies of six months or less, and does not require prescription drug coverage unless the enrollee already has a prescription drug plan.
HB4740 would amend MCL 500.3406s in the Insurance Code of 1956, refining the statutory requirements for autism-related health coverage in Michigan. It would continue to impose mandatory autism diagnosis and treatment coverage on most health insurance policies while preserving insurer tools such as utilization review, coordination of benefits, and managed care cost-containment practices. The bill would primarily affect health insurers, enrollees with autism spectrum disorders, providers delivering ABA and related therapies, and families seeking coverage for autism services.
The bill appears generally supportive of autism coverage and consumer access to treatment, with no recorded committee transcripts or votes indicating organized opposition in the provided materials. Its structure suggests a policy balance between expanding and preserving coverage for autism services and maintaining insurer oversight and cost controls. Overall, the sentiment reflected in the text is favorable toward continued mandated coverage, especially for children with autism.
The main points of potential contention are the age-based annual benefit caps, the limit of coverage to age 18, and the insurer’s ability to require treatment plans, diagnostic documentation, and periodic reevaluations. Advocates for autism services may view the caps and age limits as restrictive, while insurers may view the bill’s mandatory coverage and prohibition on visit limits as costly. Another possible area of debate is the bill’s interaction with federal Affordable Care Act essential health benefits, which limits how far the mandate extends in exchange-based qualified health plans.