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Welcome #34! Oregon Enacts Autism Insurance Reform

SALEM (August 14, 2013) -- Governor John Kitzhaber today signed SB.365 into law, making Oregon the 34th state to enact autism insurance reform by requiring coverage of applied behavior analysis (ABA).

Sponsored by Sen. Alan Bates of Medford [pictured], the new law will take effect in 2015 for public employees and 2016 for state-regulated health plans. It was approved unanimously by the Legislature. Oregon joins Minnesota and the District of Columbia which also enacted autism insurance reform this year.

“Senator Bates has demonstrated leadership on an issue of critical concern to thousands of Oregon families,” said Lorri Unumb, Esq, Autism Speaks vice president for state government affairs. “His leadership and perserverance through the years will bring relief to families who have struggled financially to provide essential therapies for their children with autism.

"We commend Governor Kitzhaber for working with the Legislature and stakeholders to produce this final legislation," she said. “With autism now affecting 1 in every 88 American children and on the rise, Oregon's political leaders recognized that doing nothing in the face of an epidemic was no longer an option.”

The new law establishes requirements for state-regulated health plans to approve and manage autism treatment, including ABA and any other medical or mental health services identified in an individualized treatment plan. The law applies to kids who begin treatment before age 9, covering up to 25 hours of ABA per week, and continuing for as long as medically necessary regardless of age.

A seven-member Behavior Analysis Regulatory Board will be created within the Oregon Health Licensing Agency to license providers.

Existing Oregon laws requiring coverage of autism treatment continue to apply to older patients and those seeking more than 25 hours of ABA per week.

The new law will also impact Medicaid coverage through the Oregon Health Plan. The Oregon Health Evidence Review Commission (HERC) is required to review ABA in order to update the state’s prioritized list of health services covered through Medicaid. HERC began the study before the bill was signed by Kitzhaber.

The Oregon Health Plan must implement any new ABA services that HERC recommends by October 1, 2014, if new medical coding isn’t required, and by April 1, 2015, if new coding is necessary.

ABA has been endorsed as an evidence-based treatment for autism by the American Medical Association, the American Academy of Pediatrics and the U.S. Surgeon General.

Kitzhaber in July signed a related measure, SB.414, sponsored by Senator Chip Shields of Portland, which strengthens the enforcement powers of the state Insurance Division. The agency is now able to order health plans to pay restitution to consumers if they violate the law or their contracts. State regulators previously had very limited enforcement powers over the insurance industry which has an exemption under Oregon's anti-fraud laws.