Missouri parent and advocacy group publishes Q&A about autism insurance coverage legislation
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A bill that would require insurance coverage for the diagnosis and treatment of autism will be introduced at the next Missouri legislative session. Yet, many Missourians are still unclear about the details -- what the bill will and will not include, the dollar limit of what will be covered, and what, if any, additional premium costs will households and companies need to bear if the law is passed. To help constituents better understand the impact of an autism insurance coverage law, MO-FEAT and the Missouri Autism Commission have released a question and answer document, which is reprinted below:
Questions and Answers on Legislating Autism Insurance Coverage in Missouri
Why is this bill important? Most insurance companies in Missouri do not cover basic treatment for children with autism spectrum disorders. If families lose their insurance coverage, it is difficult for them to find new insurance to cover even basic medical care for their child with autism, let alone treatment. Research tells us that early and effective treatment is vital for helping children with autism to make maximal progress. Through this bill, Missouri will join 15 other states in requiring insurance coverage for autism-related services. There are only 5 states that have not either passed or considered mandating autism coverage.
Who should pay for the costs associated with autism? Autism is a neurological medical issue that requires both medical and educational intervention. Neither system can meet all of the needs, and both systems are in need of repair. Many school districts report that their staff do not feel competent in meeting the needs of students with autism. Many districts do not offer ABA services, and do not utilize the training and consultation available through Project ACCESS (DESE) in part due to funding issues.
What is the truth about cost? Actuarial data has repeatedly shown a less than 1% increase in premiums even when small businesses are included. In a recent study on the impact of autism coverage on private insurance premiums concludes that an average family would pay an additional 54 cents a month or $6.44 a year if their company provided autism coverage (Boulder, Spielman,& Mandell, 2008)
What treatments does the bill address? This bill focuses on diagnostic and treatment services for autism that are medical in nature which are prescribed by a physician or licensed psychologist, including but not limited to speech, occupational (OT), and physical therapies (PT); psychological services; and applied behavior analysis, which research tells us is one of the most effective intervention for autism.
Shouldn’t children get treatment through their school? Many children with autism receive special services at school that are related to their child’s education. However, children with autism often need help beyond their educational needs, as these children have needs within the medical realm as well. Families need access to behavioral treatment, medical consultation, specialized equipment such as speech generating devices, and additional therapies that the school may not provide.
I heard this is an “ABA bill”. Does it only cover ABA? The intent of the bill is to cover a variety of therapies in order to meet a variety of needs. The Missouri bills filed in 2008 included coverage for common therapies (Speech Therapy, OT, PT), psychological treatment, medication, equipment (such as augmentative communication devices) and more. The insurance bill for autism is based on model legislation from other states. Many of these bills have included ABA specifically because ABA would likely be excluded from coverage if it wasn’t mentioned in the bill.
Why is the bill specific about types of ABA providers? We will have to wait until bills are filed, however, to know an exact answer to this question, keeping in mind that the bills will be modified over the course of the legislative session. This bill specifies that services provided by Board Certified Behavior Analysts (BCBA’s) should be reimbursed. National certification standards require BCBA’s to supervise services provided by ABA providers with less experience and training. Services provided by Board Certified Associate Behavior Analysts (BCABA’s) and ABA Implementers would likely still be reimbursable, as long as a BCBA is providing supervision.
Are there restrictions, such as age limits or dollar amount caps? Age caps and dollar limits are among the most logical restrictions on insurance bills. The 2008 senate bill when filed covered individuals under the age of 18 for all benefits, except for ABA which was covered until age 15 and had a cap of $72,000 on ABA. The bill was later changed to a $55,000 cap. The house bill when filed provided coverage for individuals under the age of 21. The house bill had a cap on ABA benefits of $72,000 per year for individuals under age 11 and $36,000 per year for individuals between 11 and 21 years.
Who does this bill cover? In Missouri, health care for children is covered by Medicaid, private insurance through employers, and private insurance purchased by individuals. If a bill is passed, insurance coverage for autism would likely apply to private insurance available through some employers. The coverage would likely not apply to individual policies, although legislation could mandate that individual policyholders must be offered insurance coverage for autism-related services. The bill does NOT cover businesses with self-insured health plans, companies that fall under ERISA, or Medicaid plans. Your employer’s human resources department would be able to tell you whether Missouri laws affect your insurance policy or not. In other states, some large businesses which fall outside of the state mandate have voluntarily offered coverage for autism-related services.
Will my therapist be able to bill for RDI? This bill does not directly mention methodologies that have copy-rights like Relationship Development Intervention (RDI). If you were receiving reimbursement for RDI prior to now, the insurance legislation should not change that.
When would the bill go into effect? If passed, most likely the bill would go into effect in August 2010.
What happened with last year’s insurance bills? Legislation for autism insurance coverage was introduced in the Senate by Senator Scott Rupp (R) and did pass. The House version of this bill was introduced by Representative Dwight Scharnhorst (R). Autism legislation was discussed in House committees but never made it to debate on the floor of the house; although it was widely expected to pass had it been brought to a vote.
Will the bills filed this year be the same as the ones filed in 2008? Since the legislation is not yet filed, no specific wording is available yet. Bills can be filed beginning December 1. Even after a bill is filed, details will likely continue to change as the bill is negotiated. All the Missouri bills filed in 2009 had age limits and dollar caps. Some states have passed legislation without these types of limits, but most states have restrictions.
What did the Blue Ribbon Panel on Autism say about insurance? Insurance coverage was a specific recommendation made by the Missouri Blue Ribbon Panel on Autism in 2007. While services for autism may be offered through state agencies, the panel found that the Department of Mental Health (DMH) system is already over-crowded. There are waiting lists for the urban Autism Projects which distribute funds through DMH. In order to address a public health issue of this magnitude, all parties must do their part, including health insurers.
What if Missouri legislators choose not to cover autism treatment at an appropriate level of care?
The estimated public cost of untreated autism is a staggering $2.5 million over the lifetime of one child. Continuing to allow insurance discrimination contributes to financial hardship on families and increases their reliance on public assistance. Increasing the number of children on Medicaid provides no benefit to Missouri.
What is the benefit to Missouri if this bill is passed? Cost-benefit research on early intensive behavioral intervention (EIBI) for autism is compelling. Texas researchers estimated that providing Early Intensive Behavior Intervention for autism would save their state over $2 billion over the school lives of these children.
Produced For Families by Families – October, 2009Missouri Families for Effective Autism Treatment (MO-FEAT) and the Missouri Autism Coalition
Related Article: Testimony uncovers complex issues underlying autism healthcare legislation
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Missouri parent and advocacy group publishes Q&A about autism insurance coverage legislation
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