Pa. Lawmakers Compromise On Bill To Require Autism Insurance

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Pa. Lawmakers Compromise On Bill To Require Autism Insurance

Martha Raffaele. http://tinyurl.com/467swl

HARRISBURG, Pa. (AP) - Parents of autistic children would be able to

pay for behavioral therapy and related services with private health

insurance starting next year, under legislation that strikes a

compromise between the insurance industry and advocates for the disabled.

The House of Representatives on Tuesday unanimously passed the

measure, which also would give the state Insurance Department power to

approve the proposed merger of Pennsylvania's two largest insurance

companies. The Senate's Republican leader said Wednesday he expects

that chamber to send the bill to Gov. Ed Rendell, who said he would

sign it, before the Legislature's two-month summer break.

Autism is a complex developmental disorder that is often not diagnosed

in children until after age 3, and can impair a person's ability to

communicate and interact with others. Its severity varies from person

to person.

" It's so critical for these families ... when you live with the

tragedy of people rejecting their kids as if they don't have value,

because we don't provide the services that are necessary to their

developmental achievement, " said House Speaker Dennis O'Brien,

R-Philadelphia, a longtime advocate for the disabled whose 22-year-old

nephew has autism.

The bill would require insurers to provide up to $36,000 in coverage

initially for autism therapy for people under 21; the state's Medicaid

program would pay for any costs that exceed that cap. Businesses with

51 or more employees would have to offer the coverage starting July 1,

2009, while smaller businesses would not have to provide any autism

coverage.

Nearly two dozen other states have laws mandating some level of autism

insurance coverage, according to the National Conference of State

Legislatures.

Pennsylvania officials have estimated that more than 21,000 children

between the ages of 2 and 20 have autism and related disorders. About

13,800 of them are insured under the state's Medicaid program.

But Medicaid coverage has shortcomings because a limited number of

treatment providers accept it and the benefit is limited to the most

severely disabled children, among other reasons, according to a recent

Pennsylvania Health Care Cost Containment Council analysis of the

legislation.

Insurance companies argued that a mandate would be too expensive. But

they ultimately accepted a version of the bill that would require

coverage for services that either improve children's behavior or help

them maintain their developmental progress — something O'Brien said

would preserve services for children receiving Medicaid insurance when

their coverage switches to a private insurer.

" It is a reasonable balance of legitimate, competing concerns, " said

Sam Marshall, president of the Insurance Federation of Pennsylvania.

The legislation is expected to save the Medicaid program $13 million

in the 2009-10 fiscal year. The health care council estimated that the

proposal would cost the average policyholder about $1 a month in premiums.

Amity of Monroeville, whose 10-year-old son and 7-year-old

daughter both have autism, said she hoped the expected savings would

enable the state to spend more Medicaid dollars on services for adults

with autism, such as job training.

" That's a critical need, because after high school we are definitely

going to need services for them ... so they can live as healthy and as

independently as they are able, " Amity said.