Vermont Act 158 Coverage for diagnosis and treatment of early childhood developmental disorders, including autism spectrum disorders.
As one of the key advocates who helped get this law passed, Ms. Pringles is committed to ensuring that all individuals who wish to seek treatment for autism can have access to therapy. Ms. Pringles can assist parents/caregivers and providers with information about the law and instructions on navigation. She is available to conduct workshops throughout Vermont on the nuts and bolts of getting services.
More than 30 states now have laws requiring insurance companies to pay for medically necessary treatments for the condition of autism. The extent of coverage varies widely from state to state. Vermont is a unique state as our law specifically includes children covered by Medicaid in addition to private insurance coverage like in other states which have passed similar laws. Our state is also one of three that has expanded coverage beyond autism and includes “early childhood developmental disorders”.
The law covers therapies at home and in the community and is not impacted or limited by a child’s IEP/504 plan or in need of approval by a child’s IEP team or Section 504 team. The coverage also does not impact or limit other services, such as Personal Care Services.
One of the challenges that families face in getting these needed services for their disabled children is knowing how to navigate what is for many a new system of services. Please contact our office for more assistance so that your child can access therapy.
What is Act 158?
Summary of the law:
- Covers individuals with autism and early childhood developmental disabilities from birth to age 21.
- Applies to private insurers such as Cigna, MVP and Blue Cross/Blue Shield and to state public programs, including Medicaid.
- Does not apply to self-insured plans as these plans are regulated under federal laws (ERISA). Many large companies are self insured. Check with your human resources department. Some self insured companies voluntarily provide coverage.
- Covers evidenced based treatments, such as ABA (Applied Behavioral Analysis), Speech Therapy, Occupational Therapy, Physical Therapy, etc.
- Has no annual dollar caps.
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