Maryland Statutes
Subtitle 8 - Required Health Insurance Benefits
Section 15-835 - Required Coverage for Habilitative Services

(a)    (1)    In this section the following words have the meanings indicated.
        (2)    “Habilitative services” means services and devices, including occupational therapy, physical therapy, and speech therapy, that help a child keep, learn, or improve skills and functioning for daily living.
        (3)    “Managed care system” means a method that an insurer, a nonprofit health service plan, or a health maintenance organization uses to review and preauthorize a treatment plan that a health care practitioner develops for a covered person using a variety of cost containment methods to control utilization, quality, and claims.
    (b)    This section applies to:
        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and
        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
    (c)    (1)    An entity subject to this section:
            (i)    shall provide coverage of habilitative services for insureds and enrollees who are children until at least the end of the month in which the insured or enrollee turns 19 years old; and
            (ii)    may do so through a managed care system.
        (2)    An entity subject to this section is not required to provide reimbursement for habilitative services delivered through early intervention or school services.
    (d)    An entity subject to this section shall provide notice annually to its insureds and enrollees about the coverage required under this section:
        (1)    in print; and
        (2)    on its Web site.
    (e)    Beginning November 1, 2013, a determination by an entity subject to this section of whether habilitative services covered under this section are medically necessary and appropriate to treat autism and autism spectrum disorders shall be made in accordance with regulations adopted by the Commissioner.

Structure Maryland Statutes

Maryland Statutes

Insurance

Title 15 - Health Insurance

Subtitle 8 - Required Health Insurance Benefits

Section 15-801 - Benefits for Alzheimer's Disease and Care of Elderly Individuals

Section 15-802 - Benefits for Treatment of Mental Illnesses, Emotional Disorders, and Drug and Alcohol Misuse

Section 15-803 - Payments for Blood Products

Section 15-804 - Coverage for Off-Label Use of Drugs

Section 15-805 - Reimbursement for Pharmaceutical Products

Section 15-806 - Choice of Pharmacy for Filling Prescriptions

Section 15-807 - Coverage for Medical Foods and Modified Food Products

Section 15-808 - Benefits for Home Health Care

Section 15-809 - Benefits for Hospice Care Services

Section 15-810 - Benefits for in Vitro Fertilization

Section 15-810.1 - Coverage for Standard Fertility Preservation Procedures

Section 15-811 - Hospitalization Benefits for Childbirth

Section 15-812 - Inpatient Hospitalization Coverage for Mothers and Newborn Children

Section 15-813 - Benefits for Disability Caused by Pregnancy or Childbirth

Section 15-814 - Coverage for Breast Cancer Screenings

Section 15-815 - Coverage for Reconstructive Breast Surgery

Section 15-816 - Benefits for Routine Gynecological Care

Section 15-817 - Coverage for Child Wellness Services

Section 15-818 - Benefits for Treatment of Cleft Lip and Cleft Palate

Section 15-819 - Coverage for Outpatient Services and Second Opinions

Section 15-820 - Benefits for Orthopedic Braces

Section 15-821 - Diagnostic and Surgical Procedures for Bones of Face, Neck, and Head

Section 15-822 - Coverage for Diabetes Equipment, Supplies, and Self-Management Training

Section 15-823 - Coverage for Osteoporosis Prevention and Treatment

Section 15-824 - Coverage for Maintenance Drugs

Section 15-825 - Coverage for Detection of Prostate Cancer

Section 15-826 - Coverage for Prescription Drugs

Section 15-826.1 - Coverage for Contraceptive Drugs and Devices

Section 15-826.2 - Coverage for Male Sterilization

Section 15-826.3 - Coverage for Fertility Awareness-Based Methods

Section 15-827 - Coverage for Patient Cost for Clinical Trials

Section 15-828 - Coverage for Charges Related to Dental Care

Section 15-829 - Coverage for Detection of Chlamydia

Section 15-830 - Referrals to Specialists

Section 15-831 - Coverage of Prescription Drugs

Section 15-832 - Coverage for Removal of Testicle

Section 15-832.1 - Inpatient Hospitalization Coverage Following Mastectomy

Section 15-833 - Extension of Benefits

Section 15-834 - Coverage for Prostheses

Section 15-835 - Required Coverage for Habilitative Services

Section 15-836 - Hair Prosthesis

Section 15-837 - Colorectal Cancer Screening Coverage

Section 15-838 - Hearing Aid Coverage for a Minor Child

Section 15-839 - Coverage for Treatment of Morbid Obesity

Section 15-840 - Coverage for Medically Necessary Residential Crisis Services

Section 15-841 - Coverage for Smoking Cessation Treatment

Section 15-842 - Copayment or Coinsurance for Prescription Drugs and Devices Limited

Section 15-843 - Coverage for Amino Acid-Based Elemental Formula

Section 15-844 - Benefits for Prosthetic Devices

Section 15-845 - Coverage for Refills of Prescription Eye Drops

Section 15-846 - Coverage for Cancer Chemotherapy

Section 15-847 - Coverage for Specialty Drugs

Section 15-847.1 - Copayment or Coinsurance Limits for Certain Drugs -- Annual Increase Regulated

Section 15-848 - Coverage for Ostomy Equipment and Supplies

Section 15-849 - Coverage for Abuse-Deterrent Opioid Analgesic Drug Products

Section 15-850 - Prior Authorizations for Opioid Antagonist

Section 15-851 - Prior Authorization for Drug Products to Treat Opioid Use Disorder -- Prohibition

Section 15-852 - Prorated Daily Copayment or Coinsurance Amount for Partial Supply of Prescription Drug

Section 15-853 - Coverage for Lymphedema Diagnosis, Evaluation, and Treatment

Section 15-854 - Prior Authorization for Prescription Drug

Section 15-855 - Coverage for Pediatric Autoimmune Neuropsychiatric Disorders

Section 15-856