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MO Regulator: Autism Insurance Reform Works

(March 21, 2014) -- Missouri Department of Insurance Director John M. Huff said over 3,000 individuals accessed autism-related treatment in 2013 because of the state's autism insurance reform law, a 22 percent increase over 2012. 

"Missouri's landmark autism insurance law continues to deliver benefits for families impacted by autism," Huff said in an address to the St. Louis Autism Partners. "Especially encouraging is the low impact these benefits have had on overall health claim costs. I again applaud Gov. Jay Nixon and members of the General Assembly for passing this common-sense legislation to improve health care for thousands of Missouri familes."

Huff noted that the department's annual Autism Report found that insurance claims for autism-related treatments totaled $8.2 million in 2013, representing  2/10 of 1 percent of the more than $4 billion in health claims paid by Missouri health insurers. Although Missouri law does not require health insurers to submit their rates to the state, Huff said the claims data suggest minimal, if any, impact on the premiums consumers pay.

Nixon signed the 2010 law which requires state-regulated health plans to cover specific autism therapies, including applied behavior analysis (ABA). The report found autism treatments have increased more than 92 percent since 2011.

Other findings from the report include:

  • Across all market segments, the average per member, per month cost in 2013 for all autism-related claims was 48 cents, and 22 cents for ABA treatments
  • More than 1.3 million individuals received coverage from a licensed insurer. Adding public employees and other self-insured entities, the department estimates that as many as 1.6 million individuals have benefited from the autism mandate
  • All policyholders in the large- and small-group markets now have insurance coverage for autism
  • The law allows insurers in the individual market to offer extra coverage for autism for an additional cost. Some companies offer it as a standard provision in every policy. As a result, about one-third of consumers enrolled in the individual market have this coverage.

The Department of Insurance offers online resources for families and health care providers. Consumers and providers with complaints or questions are encouraged to call the department's Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.

St. Louis Autism Partners is composed of executive directors of autism organizations in the St. Louis metro area.