Arizona Autism News:
AUTISM SPEAKS HAILS GOVERNOR JAN BREWER FOR CRITICAL VETO THAT WILL ENABLE ARIZONA FAMILIES TO CONTINUE TO RECEIVE INSURANCE COVERAGE FOR AUTISM DIAGNOSIS AND TREATMENT
NEW YORK, N.Y. (April 29, 2011) – Autism Speaks, the nation’s largest autism science and advocacy organization, joined families across Arizona and around the country today in applauding Arizona Governor Jan Brewer for her courageous veto of Senate Bill 1593, misguided legislation that would have essentially reversed enacted autism insurance reform legislation and forced families to once again pay tens of thousands of dollars a year out-of-pocket for critical autism diagnoses and treatments -- even though they already have health insurance coverage.
“Governor Brewer showed remarkable leadership by standing up for the best interest of Arizona’s families and ensuring that Arizonans’ health care plans will continue to be regulated by Arizona law,” said Peter Bell, Autism Speaks executive vice president of programs and services. “We thank Governor Brewer for making this decision, which took incredible courage and will have an enormously positive impact on families affected by autism across the state. We also ask that the autism community at large take the time to thank Governor Brewer personally."
Autism Speaks launched a major traditional media, social media and grassroots campaign to persuade Governor Brewer to veto the bill, including a significant television ad buy. Advocates in Arizona and all across the country worked hard for two weeks contacting Governor Brewer to convince her that signing SB 1593 into law would be detrimental to both Arizona citizens and the autism community at large.
Arizona is one of 25 states that have enacted autism insurance reform measures. Arizona’s “Steven’s Law,” enacted in 2008, requires insurers to cover up to $50,000 a year for Applied Behavior Analysis therapy for children until age nine, and $25,000 a year for children until age sixteen. It covers therapy for children whose diagnoses reflect the full range of the autism spectrum. Applied Behavior Analysis (ABA) is recognized by the American Academy of Pediatrics and the U.S. Surgeon General, among others, as an effective, evidence-based treatment for children with autism.
In many states, health insurance policies explicitly exclude coverage of these therapies , placing a significant financial burden on families seeking to provide their children with necessary services.
Autism Speaks Launches Major TV Ad Blitz Calling On Governor Brewer to Veto Misguided Arizona Legislation That Would Reverse Autism Insurance Law (April 18, 2011)
Autism Speaks Denounces Arizona Legislation That Would End Insurance Coverage For Autism Diagnosis and Treatment, Devastating Families Across the State (April 15, 2011)
Autism Speaks Joins the Arizona Autism Community in Hailing Governor Janet Napolitano and State Legislators for Enacting Autism Insurance Legislation (March 21, 2008)
Autism Insurance Bill Introduced in Arizona State Legislature (January 29, 2008)
FAQs on Arizona's Autism Insurance Reform Law:
1. What does Arizona’s autism insurance bill (“Steven’s Law”) do?
Broadly speaking, the act requires many private insurers to begin covering the costs of diagnostic assessments for autism and services for individuals with autism who are under the age of 16. Insurance providers can limit the coverage for behavioral therapy in the following manner:
- Benefits up to $50,000 per year for a child under 9;
- Benefits up to $25,000 per year for a child ages 9-15.
2. When does the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect?
The law went into effect July 1, 2009.
3. Once the act goes into effect, will my employer-provided health insurance be required to cover my child’s autism services?
Each group health insurance provided by a hospital or medical service corporation, a health care services organization, group disability insurers, or blanket disability insurers will be required to provide coverage for the diagnosis and treatment of autism spectrum disorders.
4. What happens if we get our insurance through a "small employer” (50 or fewer) or through an employer that self-insures?
Insurance provided by a small employer or an employer that self-insures is not subject to the requirements of this act.
5. What if we purchase individual health insurance?
Purchased individual health insurance plans are not subject to the requirements of this act.
6. Are there limits on what our private insurance is going to be required to cover?
Yes. Insurance providers are required to cover medically necessary behavioral therapy services. There is an annual dollar cap on coverage of behavioral therapies that varies according to age – $50,000 for children under 9; and $25,000 for children ages 9-15. There are no limits on the number of visits to a provider. Coverage may be subject to other general limitations and exclusions of the group health insurance policy. However, an insurer cannot place higher deductibles or coinsurance provisions based solely on the diagnosis and treatment of an autism spectrum disorder. Insurance companies are not required to cover services provided outside of Arizona.
7. What coverage is mandated by the law?
The act requires coverage for medically necessary behavioral therapy services provided in the state of Arizona. The act also requires coverage for evaluations and tests needed to diagnose and assess your child’s autism disorder.
8. Is applied behavioral analysis (ABA) covered?
Yes, the law’s definition of “behavioral therapy” specifically includes ABA.
9. Will all of the Autism Spectrum diagnoses be covered, or just those diagnoses with the keyword of "autism?"
Coverage is required for Autistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified, as each is defined in the current edition of the Diagnostic and Statistical Manual (DSM).
10. Does Autism Spectrum Disorder (ASD) have to be the primary diagnosis for the child in order to qualify for coverage under act?
No, there is no requirement that ASD be the “primary” diagnosis for your child to qualify for coverage under that act.
11. Is Case Management covered?
No, insurance providers are not required to cover Case Management.
12. Who determines what services are medically necessary?
The law requires that the services be provided or supervised by a licensed or certified provider in order to be eligible for coverage.
13. Will the new law require insurance companies to cover the cost of social groups? Must it be prescribed by a physician?
The act does not include a "list" of covered services. Rather, the law requires coverage for behavioral therapy. Therefore, coverage under the bill will be determined by the insurance company based on the requirements of the law, whether the treatment is medically necessary, and whether it was provided or supervised by a licensed or certified provider.
14. Can insurance providers charge higher coinsurance, copayments, deductibles, or other out-of-pocket expenses for services for the treatment of ASD?
No, insurance providers may not charge higher coinsurance or deductibles for the diagnosis and treatment of an autism spectrum disorder than for the diagnosis and treatment of any other medical, surgical, or physical health condition under the policy.
15. What is “utilization review”?
“Utilization review” refers to techniques used by health carriers to monitor the use of, or to evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures or settings. Some examples of techniques used include ambulatory review, prospective review, retrospective review, second opinion, certification, concurrent review, case management or retrospective review. (Source: National Association of Insurance Commissioners)
16. What is “grievance review”?
“Grievance review” refers to a health carrier’s internal processes for the resolution of covered persons’ complaints. The complaints may arise out of a utilization review decision or involve the availability, delivery or quality of health care services; claims payment, handling or reimbursement for health care services; or matters pertaining to the contractual relationship between a covered person or health carrier. Some states may call it an “internal appeal” process. (Source: National Association of Insurance Commissioners)
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