Autism advocates divided on NY insurance bill

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Autism advocates divided on NY insurance bill

August 22, 2010 10:49 AM ET

By MICHAEL VIRTANEN

ALBANY, N.Y. (AP) - Legislation that would require health insurers to cover

screening, diagnosis and lifetime treatment of autism spectrum disorders has

reached Gov. Paterson's desk, but it falls short with some advocacy

groups.

The bill, approved unanimously by the Senate and Assembly, would require the

state Department of Health to identify treatment and therapy options that are

evidence-based, peer-reviewed and clinically proven. Regulations specifying what

will be covered would have to be drafted within a year, in consultation with

insurance companies and mental health and disabilities experts. Insurers could

review individual coverage to confirm it's medically necessary.

Autism spectrum disorders impair thinking, feeling, speaking and the ability to

relate to others, the National Institute of Mental Health says. Usually first

diagnosed in early childhood, they range from a severe form called autistic

disorder to a much milder form, Asperger's syndrome.

One of every 110 children in the United States has autism, the U.S. Centers for

Disease Control estimates. In New York, schools have classified 17,000 students

from ages 4 to 21, said state lawmakers sponsoring the legislation.

Bill supporters say the mandate will expand coverage for accepted approaches

like routine toddler screening, speech and behavioral therapy and anti-seizure

drugs.

" Those are all things we think will be covered, " said Paige Pierce, executive

director of Families Together in New York State. Pierce, whose son is autistic,

said the bill is clearly a step forward.

Twenty-three other states have adopted similar measures, said Judith Ursitti of

Autism Speaks.

Opponents say the bill gives give insurance companies standards to use in

rejecting treatments for a disorder that differs widely and whose cause has not

been identified.

" Without a firm cause, there's no known standard of care, " said ,

chairman of the Foundation for Autism Information & Research, who also has an

autistic son. He said it would " handcuff doctors, " who might, for example,

prescribe off-label drugs.

Both sides agree that current insurance coverage isn't adequate. With Medicaid

as the main source of reimbursement, parents of young children often spend

thousands of dollars annually for therapy and treatment. The expense declines

when children begin getting services through school.

Autism disorders can be a lifelong issue. Statistics show 79 percent of young

adults with autism still live with their families, said Marcia Roth of the

Autism Action Network. That includes her adult son, she said.

complained that the lobbyist influential in the writing of this bill,

former gubernatorial candidate Faso, works for Manatt, Phelps & , a

company whose clients include many large insurance companies. fears

insurers wanted to tailor a narrow bill that would cost them less money. Faso

said while the firm has many clients in many states, he was working in this

instance for Autism Speaks.

The Health Plan Association, which represents insurers, generally opposes

mandates because they increase the cost of health care, and found this one

particularly troubling because it has no annual or lifetime cap on what could be

paid for services, according to spokeswoman Moran.

Training parents to use behavior management techniques, combined with

medication, reduces serious behavioral problems in children with autism spectrum

disorders when compared to medication use alone, the Journal of the American

Academy of Child & Adolescent Psychiatry reported in December.

Opponents say the new regulations would raise state costs. Supporters say the

increase would be an expected 1 to 2 percent rise in health care premiums.

Paterson will review the bill when it reaches his desk, spokeswoman Maggie

McKeon said Friday.

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Online:

Recent autism research: http://iacc.hhs.gov/summary-advances/2009/index.shtml

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