Autism Speaks Announces Multi-State Insurance Legislation Campaign
Florida, California, Michigan and Pennsylvania are Key Battlegrounds in Effort to Change Insurance Laws and Require Coverage of Medically Necessary Services
PALM BEACH, FL (December 27, 2007) – Autism Speaks, the nation's largest autism advocacy organization, will undertake a multi-state initiative to pass insurance coverage provisions for autism services, it was announced today by Co-Founders Bob and Suzanne Wright. Expanding on Autism Speaks' ongoing advocacy work in Pennsylvania, the 2008 initiative will extend to Florida, California and Michigan, battleground states in the effort to compel commercial insurers to cover evidence-based, medically necessary therapies and services for individuals with autism.
Autism Speaks leadership will begin conversations with Governor Charlie Crist and key members of the Florida legislature in a bi-partisan effort to address the insurance coverage issue in Florida. According to the most recent Department of Education statistics, Florida ranks sixth in the United States in the number of children receiving services for autism.
Most states do not require private insurance companies to cover even essential autism treatments and services. In the absence of coverage, families often pay as much as they can out-of-pocket for services that can cost upwards of $50,000 per year. In the process, many risk their homes and the educations of their unaffected children – essentially mortgaging their entire futures. Autism Speaks, together with other autism advocacy groups, is working to change state insurance laws to require private health insurance policies to cover the diagnosis and treatment of autism spectrum disorders for individuals under the age of 21.
The insurance legislation supported by Autism Speaks specifically targets coverage of Applied Behavior Analysis (ABA) and other structured behavioral therapies, which are the most effective forms of treatment and have the best outcomes, both in human costs and in long-term economic benefits. Nationwide, few private insurance companies or other employee benefit plans cover Applied Behavior Analysis and other behavioral therapies. In fact, most insurance companies designate autism as a diagnostic exclusion, meaning that no autism-specific services are covered, even those that would be used to treat other conditions.
“It's time for insurance companies to step up and assume some of the financial burden now shouldered by families and school districts,” said Bob Wright. “The autism community is mobilized and determined to go state-by-state state and knock on every legislator's door until these unreasonable insurance laws are changed. It's time to remove these barriers to care.”
“Families across the country are going broke as they struggle to provide their children with the services they need and deserve,” added Suzanne Wright. “A family should not have to choose between getting necessary therapies for their child and making their mortgage payments.”
Autism Speaks has outlined eight arguments in support of private insurance coverage of autism-related services – based on importance, efficacy, and costs associated with autism insurance coverage -- in the document Arguments in Support of Private Insurance Coverage of Autism-Related Services. It can be found here:
www.autismspeaks.org/docs/arguments_for_private_insurance_coverage.pdf.
Three states – South Carolina, Texas and Indiana – have already passed autism insurance legislation that specifically requires private insurance companies to provide coverage of ABA and other structured behavioral treatments.
Autism Speaks congratulates Speaker Dennis O'Brien, the bill's champion, and all of the families in the Pennsylvania autism community for their unrelenting effort to help get this bill passed in the House and for their continued support of this legislation as we take the fight to the Senate. We have made great progress, but we will not stop until we can say that Pennsylvania is covering our kids!
Current Status:
This winter, in 2008, the battle for autism insurance coverage is in the Pennsylvania Senate. The Autism Insurance Benefit Restoration Bill has been introduced by Senator Jane Orie and follows suit with the bill passed in the PA House.
We ask that all Pennsylvania residents continue to contact your State Senators and urge them to support the Autism Insurance Benefit Restoration Bill.
TAKE ACTION NOW!
CLICK HERE to Email your Pennsylvania State Senator Now!!
This fall, Pennsylvania State Senator Donald White, Chair of the Senate Insurance Committee, asked Pennsylvania's Health Care Cost Containment Council to review HB 1150 to determine if it has a cost benefit. The Council is nonpartisan and is charged with reviewing information that relates to specific questions on the benefits of the treatments in HB 1150. Members of the community were invited to participate in the review process by submitting any helpful documentation to the Council.
Autism Speaks submitted a report to the Council entitled, “Arguments in Support of Pennsylvania House Bill 1150.” This report contained eight arguments that prove that there is a significant long-term benefit to this legislation in terms of quality of life and savings in the long run. We are confident that the Council will use our report to come to the same conclusions.
Click here to read the Autism Speaks report (PDF).
Bill Summary Description:
(Windows Media Video, ~9 minutes)
- Amends the Insurance Company Act (Title 18-Insurance Code) to require all private insurers to pay for the provision of certain types of treatments for individuals with autism spectrum disorders.
- Amends the Insurance Company Law of 1921 by adding a new section, § 635.2.2, which requires all private health insurers to issue policies of insurance that pay for the provision of services to assist in the diagnosis and treatment of autism spectrum disorders.
- Services required to be provided in all health insurance policies include (1) habilitation care, based on the principals of applied behavioral analysis (ABA), (2) psychiatric care (3) psychological care (4) therapeutic care and (5) medications prescribed by a physician or certified nurse practitioners.
- Coverage under this new provision is limited to $36,000 per year and is subject to all co-payment, deductible and co insurance as otherwise required by the applicable policies.
- The Commonwealth's medical assistance programs are specifically excluded from the coverage requirement.
- The Governor's budget office estimates the savings to the Commonwealth's budget to be approximately $85 million dollars.
Read HB 1150
Bill Summary Description
The bill, sponsored by Sen. Brandon Shaffer and Rep. Nancy Todd, streamlines the funding process for children with developmental disabilities, including autism, so they and their families have easier access to early intervention medical care.
Read the legislation
Current Status
The bill was signed into law by Governor Bill Ritter on May 15, 2007.
Read Colorado Governor Bill Ritter's press release
South Carolina: Ryan's Law
Ryan's Law was passed by both the South Carolina House of Representatives and Senate on May 31, 2007. The bill was then vetoed by Governor Mark Sanford on June 6. On June 7, the bill was brought back to the House and Senate floors and unanimous votes in both chambers overrode the Governor's veto.
One of the most extensive autism insurance mandates in the country to date, Ryan's Law, will provide coverage for persons with autism spectrum disorder under sixteen years of age. Included is coverage for behavioral therapy up to $50,000 a year. The bill is a compromise between the South Carolina autism community and the South Carolina insurance industry.
Read the text of the legislation
Read the Autism Speaks news report
Texas Autism Insurance Bill – House Bill 1919
Texas Governor Rick Perry signed House Bill 1919 into law on June 15, 2007. The new law mandates for better insurance coverage for children with autism.
It is estimated that Texas could save up to $771.5 million in special education costs alone, within the first 10 years of the bill's passage.
Along with Sen. Eddie Lucio, who has been trying to pass the autism-insurance bill for six years, the effort to pass this bill was directed largely by Cynthia Singleton and a group of many other dedicated parents in Texas.
Bill Summary Description:
The new bill will mandate insurance companies to cover services that apply to children between the ages of three and five for autism-related services. While the Texas bill limits the ages for children who can benefit from this coverage, it goes farther than some other states in terms of spelling out exactly what kinds of services are covered. The bill's text specifically cites which kinds of autism-related services must be considered, and includes
- Evaluation and assessment services
- Applied Behavior Analysis (ABA)
- Behavior training and behavior management
- Speech therapy
- Occupational therapy
- Physical therapy
- Medication or nutritional supplements used to address symptoms of autism spectrum disorder.
Read the Autism Speaks article on the Texas Autism Insurance Bill
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