State laws on pediatric speech and OT coverage, side by side
The short answer3 states have a law on this page that bears on pediatric speech and OT: Florida, New Jersey and Texas. A state law reaches fully insured plans in that state, not self-funded employer plans. Each state's page quotes what we could read and links to it.
Unofficial source · confirm with the payer Rows marked unofficial come from a secondary source, not the statute itself.
By Javier Alvarez · Updated · 1 min read
3 rows: State law. Public policy, not the member's benefits.
Florida autism coverage mandate (speech, OT, PT)
Florida Statutes s. 627.6686, Steven A. Geller Autism Coverage Act · Florida
| Where it applies | Eligible individual means a person under 18, or 18 or older and in high school, diagnosed with a developmental disability at age 8 or younger. The term health insurance plan excludes the individual market, individually underwritten plans and small employer plans. [1] |
|---|---|
| State law | A group health insurance plan issued or renewed on or after April 1, 2009 must cover treatment of autism spectrum disorder and Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis for an eligible individual. [1] |
| Visit limits | Coverage for these services is limited to $36,000 annually and $200,000 in total lifetime benefits, adjusted each January 1 for the medical component of the CPI. [1] |
| Referral | Coverage is limited to treatment prescribed by the treating physician under a treatment plan. The plan must include the diagnosis, treatment by type, frequency and duration, goals, how often it is updated, and the physician signature. [1] |
| Payment | Dollar limits, deductibles and coinsurance may not be less favorable than those for physical illnesses generally, except for the annual and lifetime caps. [1] |
| Also | Coverage may not be denied because the services are habilitative in nature. Plans may still apply general exclusions, coordination of benefits, network rules and utilization review. [1] |
Texas autism coverage mandate (speech, OT, PT)
Tex. Insurance Code s. 1355.015 · Texas
Unofficial source · confirm with the payer: some facts in this row come from a secondary source, not the payer.
| Where it applies | NCSL says the law defines generally recognized services to include applied behavior analysis, speech, occupational and physical therapy, medications or nutritional supplements, and other treatments. [1] Unofficial source · confirm with the payer |
|---|---|
| State law | As of 2021, NCSL summarizes Tex. Insurance Code s. 1355.015 as requiring a health benefit plan to cover screening a child for autism spectrum disorder, and all generally recognized services prescribed by the enrollee's primary care physician in the treatment plan the physician recommends. [1] Unofficial source · confirm with the payer |
| Referral | Services must be prescribed by the enrollee's primary care physician in the recommended treatment plan. [1] Unofficial source · confirm with the payer |
| Payment | NCSL says this coverage may be subject to annual deductibles, copayments and coinsurance consistent with those required for other coverage under the plan. [1] Unofficial source · confirm with the payer |
- NCSL: Autism and Insurance Coverage State Laws (updated August 24, 2021) (secondary source), checked October 30, 2026
New Jersey autism coverage mandate (OT, PT, speech)
N.J. Rev. Stat. 17:48-6ii and related sections · New Jersey
Unofficial source · confirm with the payer: some facts in this row come from a secondary source, not the payer.
| Where it applies | When the covered person's primary diagnosis is autism or another developmental disability, coverage must be provided for medically necessary occupational therapy, physical therapy and speech therapy, as prescribed through a treatment plan. [1] Unofficial source · confirm with the payer |
|---|---|
| State law | As of 2021, NCSL summarizes several New Jersey statutes (including N.J. Rev. Stat. 17:48-6ii and 17B:27-46.1ii) as requiring specified health plans to cover screening and diagnosing autism or another developmental disability. [1] Unofficial source · confirm with the payer |
| Diagnoses | For a covered person under 21 whose primary diagnosis is autism, coverage must also include medically necessary behavioral interventions based on applied behavioral analysis and related programs, as prescribed through a treatment plan. [1] Unofficial source · confirm with the payer |
- NCSL: Autism and Insurance Coverage State Laws (updated August 24, 2021) (secondary source), checked October 30, 2026
3 state laws side by side
These are state laws that bear on pediatric speech and OT: who must cover it, for whom, and on what terms. A state insurance law reaches the plans that state regulates; a self-funded employer plan is regulated federally, so check the member's plan type on the benefits call.
| State | Law | What it requires |
|---|---|---|
| Florida | Florida Statutes s. 627.6686, Steven A. Geller Autism Coverage Act | A group health insurance plan issued or renewed on or after April 1, 2009 must cover treatment of autism spectrum disorder and Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis for an eligible individual. |
| New Jersey | N.J. Rev. Stat. 17:48-6ii and related sections | As of 2021, NCSL summarizes several New Jersey statutes (including N.J. Rev. Stat. 17:48-6ii and 17B:27-46.1ii) as requiring specified health plans to cover screening and diagnosing autism or another developmental disability. (Unofficial source · confirm with the payer) |
| Texas | Tex. Insurance Code s. 1355.015 | As of 2021, NCSL summarizes Tex. Insurance Code s. 1355.015 as requiring a health benefit plan to cover screening a child for autism spectrum disorder, and all generally recognized services prescribed by the enrollee's primary care physician in the treatment plan the physician recommends. (Unofficial source · confirm with the payer) |
Your state isn't here?
We only add a state when we could open a document that states the rule. Call the state's provider line or the member's plan, and ask which codes pediatric SLPs and OTs can bill, whether prior authorization is needed and how many visits a year. The pediatric speech and OT table has every payer we checked.