States mandating autism insurance coverage
Representatives from the insurance industry and CBIA spoke in opposition of the bill, mainly based on the premise that mandated benefits increase the cost of insurance.
Written testimony and relevant sections of the public hearing transcript regarding Raised Bill 5696 are enclosed for your reference.
A copy is enclosed and may be viewed at: Public Act 08-132 requires health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2009 to cover physical, speech, and occupational therapy services provided to treat autism spectrum disorders if the policies cover these services for other diseases and conditions.
It defines “autism spectrum disorder” based on the American Psychiatric Association It applies this requirement to group and individual (1) health insurance policies that cover basic hospital, medical-surgical, or major medical expenses; (2) HMO contracts covering hospital and medical expenses; and (3) hospital or medical service contracts.
Last week, I attended two separate forums on Virginia's exploding autism population, the lack of infrastructure to support it, and talking about ways to help families cope.
Requiring Virginia insurers has become a perrenial fight in the General Assembly.
The law applies to policies that disability insurers, hospital and medical service corporations, health care service organizations, and blanket disability insurers issue or renew on or after June 30, 2009, but it does not apply to a policy issued to a small employer (employs two to 50 employees).
It also does not apply to individual health insurance, long term care insurance, life insurance, annuities, and limited benefit coverage.s most recent Diagnostic and Statistical Manual of Mental Disorders.
The law specifically excludes from this coverage requirement (1) mental retardation; (2) learning, motor skills, communication, and caffeine-related disorders; (3) relational problems; and (4) additional conditions not otherwise defined as mental disorders in the DSM-IV-TR (CGS 38a-488a and 38a-514). Insurance must cover medically necessary early intervention services for a child from birth until age three that are part of an individualized family service plan.
Here is a WAMU story about this past session's efforts.
One of the big arguments against this idea is that if other states do not mandate coverage, it puts Virginia insurers and eventually companies at a competitive disadvantage with other states because their rates and costs are higher due to this additional coverage.
Yesterday, the New York Times ran a story that New York was very close to becoming the 23rd state in the country to require insurance companies to cover autism treatments.
I have several friends who face ,000 in annual medical bills paying for therapy for their children.