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Portland Takes Step One in Oregon

June 06, 2012

NEW YORK, NY (June 6, 2012) – Autism Speaks, the nation's leading autism science and advocacy organization, today applauded the City of Portland’s decision to extend autism insurance benefits to city employees, including coverage for Applied Behavior Analysis (ABA), paving the way for wider reform to be enacted at the state level in Oregon in 2013.

Through the efforts of City Commissioners Amanda Fritz and Dan Saltzman, Portland will start covering autism treatment, including ABA, for city employees and dependents on July 1 with no financial, age or visit caps. In addition, existing limitations on physical, occupational, speech and audiological therapy necessary to restore or improve lost function caused by autism will be removed.  The benefits apply to employees covered under the city’s self-funded health plan administered by ODS; employees covered under the city’s Kaiser plan will receive assistance to appeal and resolve denials of ABA therapy.

“This is an important first step in Oregon for improving access to proven therapies that can improve the quality of life for a child with autism,” said Lorri Unumb, Autism Speaks’ vice president for state government affairs. “We thank Commissioners Fritz and Saltzman for their leadership. The initiative extends important new benefits, while preserving the city’s ability to control health care costs through utilization review and preauthorization.”

The Portland decision gives a boost to efforts at the state level led by Senators Alan Bates and Mark Hass to craft an autism insurance reform bill for the 2013 legislative session. The Senators have brought together the autism community, represented by Paul Terdal of Autism Speaks, the Autism Society of Oregon, and the Oregon Association for Behavior Analysis, with representatives from the insurance industry and the state.

Under the benefit change, coverage would be provided for ABA therapy provided by Board Certified Behavior Analysts (BCBA) and line therapists under their supervision. A licensed provider will have to recommend the therapy and monitor progress. This approach, based on the national standard of care for treatment of autism, helps deliver quality care at an affordable cost by allowing paraprofessionals to help provide treatment. 

Precertification will be required based on a determination of medical necessity, with periodic utilization review to confirm whether progress is continuing. There will be no arbitrary age, dollar, or visit limits on this benefit.

In addition, the new plan will remove existing limitations on physical, occupational, speech and audiological therapy necessary to restore or improve lost function caused by autism. Prior authorization will be required, but decisions will be based on medical necessity determinations that the therapy will result in continued improvement.