Autism Insurance Parity - CoSponsor Testimony support needed REVISED DATE

[Guest guest]

PLEASE NOTE REVISED DATE

Dear Friend of ASO:

Rep. Jon and Rep. Ted Celeste have introduced HB 170 to "amend and to enact sections of the Revised Code to prohibit health insurers from excluding coverage for autism". A summarized write up on the legislation follows my signature. Complete details on the legislation can be found by going to http://www.legislature.state.oh.us/search.cfm and doing a search on HB170 in the "House" of the "127th General Assembly".

Cosponsor testimony on this bill will be held Tuesday, October 16, 2007, at 2:30pm in the Statehouse Rm. 121. At this session, only Rep. and Rep. Celeste will be allowed to testify as cosponsors of the bill. It would send a strong message to the committee if the room were filled with supporters of the legislation. If you support this effort are able to attend please do so! For directions to the statehouse, visit: http://www.ohiochannel.org/your_state/ohio_statehouse/information/contact/driving_directions.cfm

The Autism Society of Ohio and the Ohio Autism Coalition (a coalition of autism advocacy groups in the state) support this legislation and will be organizing efforts to advocate for its passage. We will be sending out an email next week detailing what information we will need and to ask for volunteers in a variety of capacities - so watch your email!

Thank you for your support.

Barbara C. YavorcikPresidentAutism Society of Ohio701 S. Main St.Akron, OH 44311(330) 376-0211fax: (330) 376-1226email: askASO@...home: byavorcik@...web: www.autismohio.org

Autism Insurance Parity

What is the History?

Thousands of families and individuals with autism have health insurance in the state of Ohio. Even with health insurance, some individuals with autism are unable to receive treatment for their autism under their health insurance plan because that insurance plan has clauses to exclude coverage for autism or developmental disabilities. This means that not only will the individual not receive treatment for autism, but the individual may also be denied medical tests such as MRI’s or EEG’s or genetic testing in order to further diagnose the disorder. Some health insurance plans may even deny treatment for medical problems unrelated to autism, such as broken bones, solely because the individual has autism. There are “fully†and “self†insured health insurance plans that do cover a variety of treatments for people with autism including psychology (which includes ABA), pharmacology, occupational therapy, physical therapy, and speech therapy. Many of these treatments are either age limited, limited by number of visits per year, have higher copays than other medical treatments, or limited by dollar amount.

Through early screening, children are diagnosed with autism at an earlier and earlier age. The earlier a child is diagnosed, the sooner the child can receive treatment. Yet some children have been denied coverage for diagnosis. The Ohio Department of Health, Bureau of Children with Medical Handicaps (BCMH) does help families cover those uncovered costs for diagnosis of autism without regard for income, but the family does need to apply prior to the diagnosis appointment. However BCMH does not cover any treatment for autism after the diagnosis is made.

What do we know about autism?

We know that autism is a disorder defined in the Diagnostic and Statistical Manual published by the American Psychiatric Association. We know that autism affects 1 out of 150 children. We know that Autism is a medically treatable disorder. Medical treatments are not the same thing as educational services. We know that there is a wealth of research pointing to genetic causes. We know that diagnosing and treating autism medically earlier in life can affect a better outcome for the person with autism and therefore it is less costly for society at large. We know that with appropriate medical treatment many people with autism can live independently and be contributing members of the community.

What does this bill do?

This autism health insurance parity bill will affect any health insurance plan that is not a self insured policy, including either individual or group plans. Affected plans are “fully†insured plans. About 40 – 50% of people who have health insurance in the state of Ohio are covered under “fully†insured plans. Many companies are “self insuredâ€, and these plans will not be affected by this bill. The state can not apply the law to those plans because they fall under federal law.

It is important to note that some insurance companies like Aetna, BCBS, and Nationwide have contracts with companies for “fully†insured plans and also have different contracts with companies for self insured plans. So once this law goes into effect on fully insured plans, it is highly likely that insurance companies will begin to recommend to companies with self insured plans to incorporate autism treatment in their plans as well.

The bill mandates that the health insurance policies providing basic health care coverage must include coverage for the diagnosis and treatment of “autismâ€. Autism means autistic disorder defined by DSM-IV. Jon mentioned that they will go back to the bill to enter language to clarify that autistic disorders includes PDD-NOS. This places Autism under basic health care (medical) services.

Here is an example of what this bill will cover: if a child or adult with autism is covered under a “fully†insured plan and if they want a type of medical treatment that insurance will normally cover then their insurance company can no longer deny coverage just because a person has a diagnosis of autism. This means if a neurologist wants to run an MRI on a newly diagnosed child, the insurance company cannot deny coverage for the test. This does not meant that treatments like chelation which might be considered to be “experimental†and not sanctioned by the FDA as a treatment for Autism will be automatically covered. There are examples of people who have obtained coverage for such treatments with their health insurance company if that company already has autism parity. In general it is possible to get coverage for medical treatment of autism if the insurance plan offers the therapy for other disorders.

Many states have included minimum and maximum amounts of coverage on their autism insurance parity bills. As a result, the insurance companies tend to make the minimum amount the same as the maximum amount. Therefore, if the bill says that the insurance company must cover a minimum of $400 of autism treatment per quarter, then that is all they cover and $400 becomes the maximum amount too.

It would be dangerous to put minimum and maximum amounts of coverage in this bill and is not included in the current version of the bill. Adding minimum or maximum amounts could hurt many people who are already getting some treatment covered by their health insurance company because it would introduce a maximum where currently none exists. For example, if a child is receiving $10,000 of coverage for therapies under their current insurance policy and a $2000 annual minimum and a $15,000 annual maximum are put in this bill, their insurance company could say that they will now cover only $2,000 per year. Therefore the child has now lost $8,000 of coverage. There are definitely plans in Ohio that cover autism treatment including drugs, psychology, speech, OT, PT, and other medically based treatments. Again these treatments have been limited by number of visits, higher co-pays, are age limited, or time limited.

What is out of scope for this bill?

Insuring the uninsured

The Single Payer issue

Self Insured plans in Ohio

Educational services

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