ACT 62 Resources

ACT 62 (Pennsylvania’s Autism Insurance Act) came into effect July 1, 2009. It is a statewide insurance mandate specific to services provided to children and adolescents who have an autism spectrum disorder (ASD).

For more information on ACT 62 for providers, families, and members, please visit the Pennsylvania Department of Human Services website.

HealthChoices Provider Information

For all members who are covered under PA ACT 62 (Autism Insurance Act), providers are required to verify benefit, coverage, and cap dollars available with private health insurance carrier(s). Community Care is considered the payer of last resort.

Commercial Provider Information

Community Care provides care management for the behavioral health services of UPMC Health Plan members under the age of 21 who have autism spectrum disorders. This is done under the coordination of UPMC Health Plan’s staff who manage the physical health care needs of this population. Providers are expected to maintain needed documentation within the member’s chart or Electronic Medical Record (EMR) for any type of clinical or billing audit. Services can be delivered with no authorization or accompanying documentation.

Care management will work collaboratively with providers, UPMC Health Plan’s Quality Department, the Department of Fraud, Waste, and Abuse, and other oversight to ensure members are provided quality treatment within best practice and industry standards. Learn more.