ANNAPOLIS (September 9, 2013) -- A Maryland proposal making clear that health insurers under existing state law must cover applied behavior analysis (ABA) and other autism therapies needs to be strengthened to maximize coverage for as many families as possible, Autism Speaks has urged in a letter cosigned by leading Maryland advocacy groups.
The regulatory proposal was developed by the Maryland Insurance Administration (MIA), which enforces state insurance law. The proposal resulted from recommendations presented by a task force which spent the past year hearing testimony on how coverage for autism therapies is routinely denied in Maryland because of the lack of clarity in existing law.
"As the (Maryland Insurance Administration) MIA finalizes these regulations, we ask that it carefully consider the real-world impact that the new rules will have on families in need of coverage," the groups wrote in a letter to the MIA. "Thousands of Marylanders stand to gain from these protections and we look forward to working with the MIA to insure that the regulations benefit as many Maryland families as possible."
Maryland is one of 16 states yet to enact autism insurance reform. Rather than push for enactment of a new law, however, advocates are working to clarify existing habilitative services law by requiring ABA coverage for autism through regulation.
In addition to Autism Speaks, the letter was signed by state Senator Katherine Klausmeir, Pathfinders for Autism, the Autism Society's Montgomery County, Howard County and Baltimore–Chesapeake chapters, The Shafer Center, the Jewish Community Relations Council of Greater Washington, and several parents.
Autism Speaks urged MIA to require that the level of habilitative services be determined by medical necessity, rather than arbitrary age limits.
"As proposed, the regulation refers to up to 25 hours of habilitative services for children aged 18 months to 6 years, and up to 10 hours of habilitative services for those aged 6 to 19 years," the letter said. "We are concerned that these hourly references --which are included to prohibit carrier denials--will be interpreted as a fixed ceiling on coverage for habilitative services."
In addition the proposed hourly limits could appear to apply to all habilitative services, not just ABA. "This puts families in the difficult position of being forced to choose between critical benefits, such as speech therapy and physical therapy or ABA," the letter said.
The advocacy groups also urged the state to accept national certification for ABA providers rather than require that they obtain a Maryland license. Such licensure issues have delayed and frustrated the implementation of autism insurance reform laws in other states, such as New York, Virginia and Rhode Island. In addition, the state was urged to clarify its definition of "habilitative services" to prevent potential delays and frustration when families file claims.
MIA will review public comments on the proposal before issuing its final version of the regulatory change. A special legislative panel must then approve the change for the new coverage to become law.
Read the collaborative letter here