NEW YORK, NY (July 15, 2011) Action on an autism insurance reform bill before the California Legislature is more urgent than ever in the wake of a settlement the state reached with a major health plan which does little to improve coverage for families, Lorri Unumb, Esq., Autism Speaks vice president of state government affairs, said today.
"Our review of the settlement announced Wednesday between the state Department of Managed Health Care (DMHC) and Blue Shield of California shows it is not the answer thousands of California families have been looking for in caring for their loved ones with autism," said Unumb. "The right answer for California families has been provided by Senate President Pro Tempore Darrell Steinberg who is sponsoring a bill which would enable California to join the 27 other states that have enacted meaningful autism insurance reform laws."
The settlement was announced during a hearing before the Senate Select Committee on Autism & Related Disorders where Unumb was invited to testify. A review by Autism Speaks of the settlement shows it presents a Catch 22 for California families who have been paying health plans thousands of dollars a year in insurance premiums, yet are denied any coverage for applied behavior analysis (ABA,) an evidence-based autism therapy, for their dependents with autism.
Reading the fine print of the settlement revealed this: it requires ABA to be supervised by a licensed provider, but no license exists in California for behavior analysts (the professionals who supervise ABA,) Unumb explained. So under this agreement, Board Certified Behavior Analysts -- the people who are trained to design and know how to supervise ABA -- cannot do so, while people who happen to be licensed in something, but have no knowledge of behavior analysis, can.
Legislatures in 27 other states have enacted laws stopping such discrimination by private insurance companies against families by requiring they cover autism therapies, such as ABA. This year alone, bills have been signed into law in Arkansas, Virginia, West Virginia and Rhode Island, while in New York a bill has been voted out of the legislature and awaits Gov. Andrew Cuomo's signature.
The Steinberg bill (SB-166,) and a companion measure (AB-171) in the Assembly sponsored by Assembly Member Jim Beall, would require health insurance companies in California to provide coverage for behavioral health treatment and would require reimbursement for a "qualified autism service provider" including state or nationally licensed or certified providers, as well as the people they supervise. There would be no cap on benefits based on age, number of visits or annual benefits.
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.
In opposing state legislative actions around the nation, insurance companies have routinely cited cost impacts on individual policies that, after years of real life experience, prove to have been inflated. Based on the experience in states which have enacted autism insurance reform laws, the impact on premiums has ranged from 0.27 percent to 0.63 percent. The early intervention provided through autism therapy, meanwhile, is expected to reduce long-term costs to state and local governments for education and services.
We applaud Senator Steinberg and Assembly Member Beall for their leadership on this issue of critical concern to thousands of California families, said Unumb. Autism Speaks is calling on the legislature to quickly pass these bills and join the growing number of states that have ended healthcare discrimination against children with autism.