Friday, April 9, 2010

Looking for a compromise

The upper and lower chambers in the Missouri legislature agree that autism insurance reform needs to take place. Both have passed bills that would require insurance companies to cover diagnosis and treatment of Autism Spectrum Disorder for children. However, over the last 3 years bills drafted have differed mostly on the age limit for coverage and the capped amount that insurance companies would be required to cover. This year is no exception, with the Senate bill proposing both higher age limit and capped amounts. The differences have halted the momentum of the issue. A House committee is reviewing the Senate bill, but a Senate committee has yet to do the same with the House bill. Meanwhile, insurance lobbyists that are opposed to the reform mandate seem to be fueling the fire, discouraging either side to compromise. Unless common ground can be decided on, the issue will go another year without reform.

Read the Missourian's coverage of the latest actions

AutsimSpeaks compares the two bills:

Senate Bill 618 - Sponsored by State Senator Scott B. Rupp (R-2)

House Bill 1311 - Sponsored by State Representative Jason Grill and Representative Dwight Scharnhorst (R-93)

  • Would require health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders

  • SB 618 requires coverage for individuals under the age of 21

  • HB 1311 requires coverage of ABA for individuals under the age of 18

  • Insurance coverage for non ABA related therapies does not have any age limits or monetary caps placed on it under under the passed House bill

  • SB 618 requires coverage for applied behavior analysis (ABA) therapy is subject to a maximum benefit of $55,000 per year

  • HB 1311 requires coverage for applied behavior analusis (ABA) therapy is subject to a maximum benefit of $36,000 per year

  • Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist in accordance with a treatment plan

  • Under this bill, health insurance companies would be required to provide coverage of the following:
    • Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing, or other testing to determine whether an individual has one or more autism spectrum disorders
    • Habilitative or rehabilitative care - meaning professional counseling, guidance, services, and treatment programs, including applied behavior analysis (ABA) and other behavioral health treatments, that are necessary to develop, maintain, and restore to the maximum possible extent an individuals functioning
    • Pharmacy care
    • Psychiatric care
    • Psychological care
    • Therapeutic care - meaning services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists, or social workers

  • HB 1311 contains an opt-out/waiver from offering ASD coverage if the employer demonstrates by actual experience over any consecutive 12-month period that the cost of providing coverage has resulted in a 2.5% increase in the health plan premiums

  • The bill does not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan

  • The bill applies only to state regulated insurance plans. It does not apply to self-funded insurance plans, as these plans are regulated by the federal government under ERISA law

  • If enacted, this bill would take effect on August 28, 2010

Friday, April 2, 2010

Happy World Autism Awareness Day!

The United Nations has recognized April 2 as World Autism Awareness Day since 2008.

People and cities all over the world did things today to recognize autism awareness. The Empire State Building in New York City was one of many buildings to "light it up blue" and representatives from Autism Speaks rang the opening bell at the NYSE. Even President Obama, a supporter of the autism movement, re-declared his dedication to the issue.

Read President Obama's remarks on WAAD