What are the Age Limits for the Autism Insurance Mandate in Maryland?
In Maryland, the autism insurance mandate provides broader protections compared to many other states. According to the state’s regulations:
- Coverage Age Limit: The mandate covers individuals up to age 21.
- Services Covered: Covered treatments include Applied Behavior Analysis (ABA) therapy, speech therapy, and occupational therapy.
It is important to note that these state-level requirements generally apply to state-regulated (fully insured) plans. If you are covered by a self-funded ERISA plan (often provided by large employers), the plan may be exempt from state mandates.
Because coverage is subject to verification and is not guaranteed, it is recommended that you:
- Contact your insurance provider directly to confirm specific benefits under your plan.
- Request a written summary of benefits to identify any potential annual visit restrictions or spending caps.
- Demonstrate medical necessity through a formal diagnosis and treatment plan from a licensed professional to unlock these benefits.
Related FAQs
-
How can I Find Aba Therapy Providers with no Waitlist?
Read More »: How can I Find Aba Therapy Providers with no Waitlist?Finding ABA therapy without an indefinite wait requires targeting providers with specific operational models and geographic flexibility. To secure immediate care, consider the following strategies: For a quick start, you can use tools like the Interactive ABA Roadmap to outline…
-
Are There Aba Providers in Utah with Immediate Openings?
Read More »: Are There Aba Providers in Utah with Immediate Openings?Yes, Golden Touch ABA Therapy provides in-home ABA therapy with no waitlist for families in Utah. They have structured their services to bypass the common 3–6 month delays found at many other centers. To secure an immediate opening in Utah,…
-
Are Self-funded Employer Plans Required to Follow State Autism Mandates?
Read More »: Are Self-funded Employer Plans Required to Follow State Autism Mandates?No, self-funded employer plans are generally not required to follow state autism mandates. While state-level autism insurance mandates require many private health insurance plans to cover treatments like Applied Behavior Analysis (ABA) therapy, these laws do not apply to every…
-
How Many Minutes of Therapy Represent One Billing Unit?
Read More »: How Many Minutes of Therapy Represent One Billing Unit?In ABA therapy billing, one billing unit represents 15 minutes of service. Standard Category I CPT codes, such as 97153 (direct therapy), 97155 (protocol modification), and 97156 (family guidance), are all billed in these 15-minute increments. The total number of…
-
How does Cpt Code 97153 Differ from 97155 in Billing?
Read More »: How does Cpt Code 97153 Differ from 97155 in Billing?In ABA therapy, CPT codes 97153 and 97155 differ primarily in the type of service provided and the professional responsible for delivering that service: Key billing similarities and requirements include: Related FAQs
