Seventeen states afford some level of coverage for autism-related services, according to a report from the Connecticut Office of Legislative Research. The report, dated December 27, 2006, came in response to inquiries from state lawmakers wondering "if health insurance policies cover physical, speech and occupational therapy for autistic children and if not, whether the legislature could require coverage."
With a rise in the prevalence of autism spectrum disorders among children in the country, a number of states have been considering proposals to require health insurers to cover autism-related services. Last month, Wisconsin Gov. James Doyle came out in support of such coverage (see more here) and the Pennsylvania legislature took up consideration of a bill that would provide coverage (read more here). New Mexico also has taken up the issue.
The Connecticut report notes that health insurance policies in the state must cover "certain mental illnesses" and that the law appears to cover the diagnosis and treatment of autism -- though it's unclear whether such treatment includes physical, speech and occupational therapy. State lawmakers "could refine the state insurance laws to specify certain coverage requirements for autism," the report says.
Interestingly, the report also notes that the state Insurance Department staff "declined to comment on the extent of coverage required for autism due to their lack of medical expertise." The agency did say that policies must cover "medically necessary early intervention services" from birth to age 3, with expense caps of $3,200 per child per year, or $9,600 per child per year until age 3.
You can find a copy of the report online here, via the Connecticut General Assembly website. The state Office of Legislative Research has an online section of the website here.
Aside from Connecticut, the report finds that six other states -- Georgia, Indiana, Kentucky, Maryland, New York and Tennessee -- have laws that specifically address insurance coverage for autism-related services.
Ten other states -- California, Illinois, Iowa, Kansas, Louisiana, Maine, Montana, New Hampshire, New Jersey and Virginia -- require coverage for autism-related services as part of laws that say insurers must cover autism as they do other mental illnesses.
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9 comments:
Do any of these states require insurance coverage of ABA services? In my opinion, that would be even more cost-effective than coverage of the other therapies. (Not that there's anything wrong with coverage of the other therapies...)
Most of the laws I've read so far are vague as to what exactly is covered. The most specific example of ABA-related coverage mandated by the government was the court case where New Jersey state employees winning a court decision that called for insurance coverage of ABA and other services. See story about this case by clicking on "courts" label. Also this issue is part of a big debate in Canada, especially Ontario, about services for people with autism.
Of course, even though GA has a law on the books mandating coverage, there are still huge loopholes--mainly the one that if you have a self-insured insurance, that law isn't worth the paper it is written on because self-funded is governed by ERISA and not state law. Until the Federal gov't passes something that affects ERISA, states that autism is medical, not psychological, and requires self-funded plans cover autism/PDD treatment the same as neurological diseases, many of us will still continue to be excluded from coverage.
I'm in Illinois and so far they have succeeded in paying for nothing.
I'm wondering how we push the issue and get coverage.
Wonder if mandated coverages, services, centers of excellence, etc. in various states is tallied in a matrix of some sort?
Also, in May Texas passed HB 1919. Excerpt: A health benefit plan must include coverage for cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological, and psychophysiological testing and treatment, neurofeedback therapy, and remediation required for and related to treatment of an acquired brain injury. see: http://www.legis.state.tx.us/billlookup/text.aspx?LegSess=80R&Bill=HB1919
I live in NYC and I know that a law regarding insurance coverage relating to autism was passed...do you know what the bill/law number is so I can read it? I have had so much trouble researching this law.
Thanks!
Regarding Anonymous' comments on 5/18/07, I feel your pain with ERISA...as a provider it has been a thorn in my side many times. I always win appeals through the state insurance board but rarely get anywhere with ERISA since the parents must bring a lawsuit...they are usually far too stressed already without having to do this! Since Texas and other states are passing legislation to include autism coverage, I am beginning a campaign to get my congressmen and senators to sponsor similar measures on the federal level. I think we should all send letters to our representatives and stir up the initiative on all fronts.
Virginia is still fighting with this. I can tell you that so far my insurance is not paying for ABA, but does cover Speech, OT and Psychologist (SP?).
Autism Mom from Missouri - There were two bills introduced in legislation this year; one in the house and one in the senate. However, House Speaker Richards killed the HB on none other than World Autism Awareness Day...how distasteful and crass. He tried to schmoose his way through stating he thought it needed committee assigned to do further research...such BS!!! It just goes to show the clout and money the insurance company lobbyists have in our state and who they have in their pockets... The Senate Bill had great success and was looking very prominent, but when it reached the senate floor it was sent to the Fiscal/Oversight committee due to the concerns of fiscal impact it could possibly have on some state agencies...the verdict is still out on this one, but the state is broke and budgets are being cut left and right so this one is basically dead and stuck in committee for the remainder of the 2009 session.
Don't worry - fear not, because we will be back in 2010, 2011 and on and on until they see the need to get this legislation.
I can only hope that once it gets passed there are not loopholes as I reading in the other comments that still prevent us from getting coverage and services. By the way ABA services are being covered at a defined amount in the bills introduced in Missouri this session.
Never quit and never give up...that's what we teach our kids and that's what we must live by.
God bless you all.
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