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HD 3734

An Act relative to the diagnosis and treatment of autism spectrum disorder

194th Legislature (2025-2026) Introduced by John Mahoney

Massachusetts bill requires health insurers to cover autism spectrum disorder diagnosis and treatment without arbitrary limits, affecting insurance costs and access for all ages.

Senate concurred
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Bill Summary · HD 3734

Legislative bill overview

HD 3734 requires health insurance plans to cover diagnosis and treatment services for autism spectrum disorder (ASD) without arbitrary limitations, denials, or delays. The bill establishes standards for insurance coverage of behavioral health services, medical services, and other evidence-based treatments for individuals with ASD across all age groups.

Why is this important

Autism diagnosis and treatment can be extremely costly, with behavioral therapies like Applied Behavior Analysis (ABA) potentially costing $40,000-$60,000+ annually. Insurance denials or coverage caps have historically forced families to choose between treatment and financial hardship, making this a critical healthcare access issue affecting thousands of Massachusetts residents with ASD.

Potential points of contention

  • Cost implications for insurers and premiums: Expanded mandatory coverage could increase insurance costs, which may be passed to consumers through higher premiums, affecting the entire insured population
  • Definition of "evidence-based treatment": Disagreement may exist over which treatments qualify as evidence-based, potentially creating disputes between insurers, providers, and families
  • Age-related coverage limits: The bill's requirement to cover all ages conflicts with some insurers' current practices of limiting ASD treatment coverage to children, raising questions about cost containment and long-term liability
  • Medical necessity determinations: Disputes over who determines medical necessity and how prior authorization processes will function under expanded coverage requirements

Compiled from official sources — confirm details with the bill’s official record.

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