Advocacy | Autism Speaks

Texas Legislature Votes to End Insurance Age Caps

Rick Remington — Mon, 20 May 2013 21:31:40 +0000

Bill eliminating age 10 cap on benefits goes to Gov. Perry

May 21, 2013

AUSTIN (May 20, 2013) -- The Texas House of Representatives approved and sent Gov. Rick Perry a bill that would eliminate age caps for receiving autism insurance benefits. Perry signed the 2007 bill that made Texas just the third state nationally to enact autism insurance reform, then a second bill in 2009 that raised the age cap from 5 to 9.

Sponsored by Senators Kirk Watson of Austin, Wendy Davis of Forth Worth and Eddie Lucio, Jr. of Brownsville, SB.1484 would take effect in September and limit annual ABA benefits to $36,000 for children aged 10 and above. Children must be diagnosed with autism by the age of 10 to gain the coverage.

The House champions for the bill included Rep. Larry Gonzales of Round Rock, Rep. Ron Simmons of Carrollton, and Rep. Senfronia Thompson of Houston.

Texas is one of four states with existing autism insurance reform laws that has considered bills to expand coverage this year. A fifth state, New Mexico, has already enacted a new law expanding its coverage to public employees. Last year, Louisana, Vermont, Virginia and Rhode Island all took action to expand coverage under their existing laws.

The Minnesota Legislature has sent Gov. Mark Dayton a bill that would make Minnesota the 33rd state to enact autism insurance reform. Dayton is expected to sign the bill shortly.

Minnesota On Track to Enact Autism Insurance Reform

Rick Remington — Sat, 18 May 2013 17:41:06 +0000

Governor expected to sign bill making Minnesota 33rd state

May 18, 2013

ST. PAUL (May 18, 2013) -- The Minnesota Legislature has sent Governor Mark Dayton a bill that would make Minnesota the 33rd state, and the first in 2013, to enact autism insurance reform. The reforms are included in an omnibus health care bill approved late Friday night 73-61 by the House of Representatives and today 39-28 by the Senate.

Governor Dayton is expected to sign the bill which would take effect in January 2014.

Sponsored by Rep. Kim Norton (DFL-Rochester), the measure applies to state-regulated large group health plans which would be required to cover speech, occupational, physical and behavioral therapy, including Applied Behavior Analysis (ABA), up to age 18. An estimated 750,000 state residents would gain coverage. State employees will be added no later than 2016.

The Dayton administration hopes to also extend coverage to the small group and individual markets through the health exchanges it creates under the Affordable Care Act.

The bill also includes co-pay relief for families covered under the TEFRA disabilities program and a $12 million early intervention program for children up to age 18 who are enrolled in the state's Medical Assistance (MA) program. The early intervention program will provide access to behavioral therapy, such as ABA, and will include training for providers in culturally appropriate techniques.

The provisions in Norton's bill were incorporated into HF.1233, the Omnibus Health and Human Services Finance Bill, which was passed by the legislature. The legislation became more urgent after a landmark 2001 court settlement with Blue Cross Blue Shield of Minnesota expired in late 2011, stripping families of the state's only coverage starting last year.

"Autism Speaks commends the hard work of Representative Norton and the Dayton administration in producing a comprehensive response to the lack of autism coverage in Minnesota," said Lorri Unumb, Esq., Autism Speaks' vice president of state government affairs. "We look forward to continuing our work with our Minnesota champions to extend coverage to all families."

In addition to Minnesota, legislatures in North Carolina, Oregon and Nebraska are considering autism insurance reform bills. Similar measures advanced earlier this year in Hawaii, Utah, Georgia and Tennessee and are expected to be considered again in 2014.

States with existing autism insurance reform laws are expanding benefits. New Mexico has enacted a new law extending benefits under its existing law to public employees. Texas is nearing a final vote to eliminate the age cap on its law and California is moving a measure to extend its 2011 law, set to expire next year, another five years to 2019.

California Senate Approves 5-Year Extension on Autism Law

Rick Remington — Thu, 16 May 2013 19:10:31 +0000

2011 autism insurance reform law would run to 2019

May 16, 2013

SACRAMENTO (May 16, 2013) -- The California Senate voted 36-0 to extend the state's 2011 autism insurance reform law, which is set to expire next year, until 2019. Sponsored by Seante President pro Tem Darrell Steinberg, the measure, SB.126, moves next to the Assembly.

Steinberg sponsored the existing 2011 law (SB.946) which is due to expire in mid-2014.

“An estimated 12,500 Californians are currently receiving early autism treatment under the 2011 law with estimated savings to taxpayers of $200 million annually in special education costs, which were previously funded by school districts or regional centers," Steinberg said after the vote. "Californians with autism now have access to the most extensive insurance coverage of any state in the nation.”

The current law requires state-regulated health plans to cover behavioral health treatment, such as Applied Behavior Analysis, consistent with other benefits covered under their policies. Insurers are also required to maintain an "adequate" network of ABA providers.

Steinberg has also committed to working with Governor Jerry Brown to restore behavioral treatment for children with autism who lost their services during the transition from the Healthy Families program to Medi-Cal.

“While SB 946 is a proud achievement, it’s not nearly enough," said Steinberg. "This year we intend to fight to make sure all kids regardless of whether they’re on public or private insurance get the benefit of behavioral therapy. We must seek to include behavioral treatment for autism in Medi-Cal Managed Health Care to ensure children receive necessary and equitable services.”

Special Needs Services for Military Hit in New Survey

Rick Remington — Thu, 16 May 2013 17:55:22 +0000

36% of special needs parents cite autism

May 16, 2013

WASHINGTON, DC (May 16, 2013) -- In its fourth annual survey of military families, Blue Star Families found widespread dissatisfaction among special needs parents in the military with medical, educational and housing services, including access to ABA. Of the 5,125 military families who responded, 19 percent said they were receiving special needs services through the military; of those, 36 percent cited autism as their child's disability.

A national, non-profit network of military families from all ranks and services, including guard and reserves, Blue Star Families conducted the online survey in November 2012 and obtained 5,125 responses from service members stationed domestically and abroad. The survey found that 31 percent of the special needs parents enrolled in the military's Exceptional Family Member Program (EFMP) felt their participation had harmed their military careers.

"Navigating the military healthcare system to obtain services can be challenging for caregivers for Exceptional Family Members (EFM)," the report said. "The National Council on Disability noted that it is even harder for young parents, those with more than one exceptional family member, those who themselves are exceptional family members, and those with a deployed service member."

Fewer than half of the families responding to the survey said they felt supported by their chain of command, the EFMP at their base or the surrounding civilian population. In addition, shortcomings were found with TRICARE, the Department of Defense health insurance program for active duty and retired personnel.

"Families may also struggle when trying to obtain recommended specialty services that are not covered by TRICARE, such as applied behavior analysis (ABA) therapy for children with autism," the report found. ABA has been restricted to active duty members by TRICARE and a one-year pilot program ordered by Congress last year for all service members has been delayed indefinitely due to budget issues. In addition, TRICARE has been sued in a federal class action suit for restricting access to ABA.

The survey also addressed the financial impact of paying out-of-pocket for services not covered under TRICARE by quoting two Navy spouses.

“He probably would’ve stayed in (active duty) if he felt that we would not have to spend so much money out of pocket obtaining speech, occupational, and physical therapy for our son,” said one. The other Navy spouse said, "Moving duty stations requires military families to re-enroll in EFMP program services. This means that children may be waiting for months, often times a year, to access services.”

Access to state Medicaid waivers also arose in the Blue Star report, which noted that every time a military family redeploys to another state they drop to the bottom of the new state's waiver list.

"Sixty-four percent of respondents reported diﬃculty accessing community/state-based supports, such as Medicaid waiver beneﬁts," the report found. "In addition, 55 percent of respondents with an EFM also reported diﬃculty ﬁnding adequate housing when relocating."

Special needs parents overall said they were satisfied with their child's educational services, until they are required to enroll into another school district as a result of redeployment. Two thirds of the respondents said educational accommodations were "challenging" following relocation.

"New school districts will honor the previous individualized education program (IEP), but the district has authority to decide how the goals and objectives will be met and it may not be through the same exact program or services," the report said.

Blue Star Families in the report urges better supports for special needs families when they relocate, including the ability to maintain Medicaid waiver services when they move to another state. Autism Speaks is supporting efforts to make TRICARE coverage of ABA for all military members permanent and at the levels prescribed by medical professionals.

NC Autism Insurance Bill Sails Out of House, On to the Senate

Rick Remington — Thu, 16 May 2013 00:55:03 +0000

Bill requiring autism coverage, including ABA, approved 105-7

May 15, 2013

RALEIGH (May 15, 2013) -- The North Carolina House of Representatives voted 105-7 for a bill that would require state-regulated health insurers to cover common autism therapies, including ABA. The measure moves next to the Senate.

North Carolina is one of just 18 remaining states yet to enact autism insurance reform.

Sponsored by Reps. Chuck McGrady (R-Henderson), Tricia Cotham (D-Mecklenburg), Tom Murry (R-Wake) and Phil Sheppard (R-Onslow), HB498 would cover speech, occupational and physical therapy; behavioral health treatment, such as Applied Behavior Analysis, would be covered for up to $36,000 a year. The bill would take effect October 1.

Benefits would be covered through age 23; children would have to be diagnosed by age 8 to qualify.

In addition, the bill would benefit military families stationed in North Carolina by removing restrictive laws that prevent providers covered under TRICARE, the Department of Defense health insurance program, from operating in the state. North Carolina is home to more than a quarter million active duty and retired military personnel stationed out of facilities such as Camp Lejeune, Fort Bragg and Pope Air Force Base.

Texas Bill Eliminating Age Caps Heads to Final Vote

Rick Remington — Tue, 14 May 2013 20:55:18 +0000

Autism insurance benefits would continue past age 10 under bill sent to House floor

May 14, 2013

AUSTIN (May 14, 2013) -- The Texas House Insurance Committee approved 6-0 a bill that would eliminate the current age 10 cap for receiving autism insurance benefits. Already approved by the Senate, SB.1484 now heads to the House Calendars Committee to be scheduled for a final vote on the House floor.

Sponsored by Senators Kirk Watson of Austin, Wendy Davis of Forth Worth and Eddie Lucio, Jr. of Brownsville, the bill eliminates the current age cap of 10 on autism insurance benefits that was enacted in 2009. When Texas became just the third state nationally to enact autism insurance reform in 2007, coverage was limited for children aged 3 to 5.

The current law requires state-regulated health plans to cover the diagnosis and treatment of autism, including behavioral health treatment, such as Applied Behavior Analysis (ABA), as well as speech, occupational and physical therapy. The age change would take effect in September if the bill becomes law and would limit annual ABA benefits to $36,000 for children aged 10 and above.

Texas is one of four states with existing autism insurance reform laws that has picked up bills to expand coverage this year. A fifth state, New Mexico, has already enacted a new law expanding its coverage to public employees.

NC Takes Big Step to Autism Insurance Reform

Rick Remington — Tue, 14 May 2013 18:49:20 +0000

Clears House Insurance Committee by 25-4 vote

May 14, 2013

RALEIGH (May 14, 2013) -- The North Carolina autism insurance reform bill cleared its first hurdle today, gaining approval 25-4 in the House Insurance Committee. North Carolina is one of 18 remaining states yet to require state-regulated health plans to cover the screening, diagnosis and treatment of autism.

The bill goes next to the House Appropriations Committee.

Sponsored by Reps. Chuck McGrady (R-Henderson), Treicia Cotham (D-Mecklenburg), Tom Murry (R-Wake) and Phil Sheppard (R-Onslow), HB498 would cover speech, occupational and physical therapy; behavioral health treatment, such as Applied Behavior Analysis, would be covered for up to $75,000 a year. The bill would take effect October 1.

In addition, the bill would benefit military families stationed in North CarolinA by removing restrictive laws that prevent providers covered under TRICARE, the Department of Defense health insurance program, from operating in the state. North Carolina is home to more than a quarter million active duty and retired military personnel stationed out of facilities such as Camp Lejeune, Fort Bragg and Pope Air Force Base.

Federal Class Action Filed Against Oregon Insurer for Denying ABA

Rick Remington — Fri, 10 May 2013 15:50:19 +0000

Providence Health Plan accused of mental health parity violations

May 10, 2013

PORTLAND (May 10, 2013) -- A federal class action lawsuit has been filed against Providence Health Plan claiming its denial of ABA coverage for autism treatment violates federal and state mental health parity laws.

Brought by the parents of two children, "A.F." and "A.P." alleges Providence “has established and carried out a deliberate company-wide policy to deny all claims for ABA treatment in violation of U.S. and Oregon law.” The mother of A.P., Lucia Alonso, lost her home to foreclsoure when she could no longer afford both her mortgage and paying her child's ABA bills out-of-pocket due to the lack of insurance coverage.

The suit claims Providence's claims denials violate the 2008 Wellstone Domenici Mental Health Parity and Addiction Equity Act, Oregon's Mental Health Parity Act, and a state statute requiring that children with pervasive developmental disorders, such asd autism, receive “all medical services, including rehabilitation services, that are medically necessary and are otherwise covered under the plan.”

The suit was filed as a bill is moving through the Oregon Legislature requiring all state-regulated health plans to cover the screening, diagnosis and treatment of autism.

Autism Speaks Joins Outcry Over Cutoff in ABA services

Rick Remington — Fri, 10 May 2013 15:03:28 +0000

Services lost as children transition from Healthy Families to Medi-Cal

May 10, 2013

SACRAMENTO (May 10, 2013) -- Autism Speaks has joined with advocacy groups from across California to protest the cutoff of ABA services for 900,000 children who are transitioning from the Healthy Families Program to Medi-Cal.

The coalition is urging Gov. Jerry Brown to require that the ABA services be retsored through Medi-Cal. Read the statement here

Kids First Bill Introduced, Autism Speaks Praises Cantor

Rick Remington — Thu, 09 May 2013 20:50:21 +0000

House Majority Leader cited for 'intellectual leadership' on autism

May 09, 2013

WASHINGTON, DC (May 9, 2013) -- House Majority Leader Eric Cantor (R-VA) has announced the introduction of the Kids First Research Act which prioritizes research funding for pediatric disorders, such as autism, in Congress.

"Autism Speaks commends Leader Cantor for making autism a national priority through the Kids First Research Act," said Autism Speaks President Liz Feld. "Cantor's intellectual leadership recognizes the urgency that thousands of families feel and experience every day. Autism is not a partisan issue and we look forward to working with leaders in Congress and the Obama Administration in crafting a national strategy to address autism."

The bill, HR.1724, is sponsored by Rep. Gregg Harper (R-MS).

Autism is the fastest growing developmental disability in the United States with 1 in every 88 children diagnosed with an autism spectrum disorder. A recent survey by the Centers for Disease Control and Prevention suggested the actual prevalence could be as high as 1 in 50.