Delaware Autism News:
Autism Speaks Endorses Delaware Autism Insurance Reform Bill
Senate Bill 22 Would End Health Care Discrimination Against Children with Autism by Requiring Coverage of Diagnosis and Treatment
NEW YORK, NY (MARCH 22, 2011) – Autism Speaks, the nation’s largest autism advocacy organization, today announced its support for S. 22, an autism insurance reform bill, in the state of Delaware. The legislation would require private health insurance companies to cover the diagnosis and treatment of autism spectrum disorder (ASD) for individuals with the disorder.
Introduced in the Delaware Senate by Senators Liane Sorenson and Catherine Cloutier, and Representative Quinton Johnson, S. 22 includes coverage of behavioral health treatments, such as Applied Behavior Analysis (ABA), an evidence-based autism therapy. Applied Behavior Analysis therapy would be limited to $36,000 per year. The bill was referred to the Senate Finance Committee.
“We applaud and thank Senators Sorenson and Cloutier, and Representative Johnson, for their leadership on this issue of critical concern to thousands of Delaware families,” said Peter Bell, Autism Speaks executive vice president for programs and services. “Autism Speaks joins Delaware’s autism community in calling on the legislature to pass S. 22 and join the growing number of states that have ended healthcare discrimination against children with autism.”
Many states do not require private insurance companies to cover even essential autism treatments and services. In the absence of coverage, families often pay as much as they can out-of-pocket for services that can cost upwards of $50,000 per year. In the process, many risk their homes and the educations of their unaffected children – essentially mortgaging their entire futures.
Twenty-four – Arizona, Arkansas, Colorado, Connecticut, Florida, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, Vermont and Wisconsin – have enacted autism insurance reform legislation. Several other state legislatures will vote on similar legislation during the 2011 session.
Summary of Delaware 2011 Autism Insurance Reform Bill
Senate Bill 22 - Sponsored by Senators Liane Sorenson (R-6) and Catherine Cloutier (R-5)
Cosponsored by Representative S. Quinton Johnson (D-8)
The bill would:
-
Require health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders for individuals age 21 and younger
-
Direct that coverage of treatments be provided when prescribed or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary.
-
Require health insurance companies to provide coverage of the following:
-
Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders
-
Behavioral health treatment - meaning professional counseling, guidance services, and treatment programs, including applied behavior analysis (ABA), that are necessary to develop, maintain, and restore, to the maximum possible extent practicable, an the functioning of an individual
-
Pharmacy care
-
Psychiatric care
-
Psychological care
-
Therapeutic care - meaning services provided by speech, occupational, or physical therapists, or an aide or assistant under their supervision
-
Any care for individuals with autism spectrum disorders that is determined by the Secretary of the Department of Health and Social Services, based upon their review of best practices and/or evidence-based research, to be medically necessary
-
Allow coverage for Applied Behavior Analysis (ABA) up to an annual maximum of $36,000, but set no limits on the number of visits to an ABA provider
-
Impose no dollar or number of visit limitations on other covered treatments unrelated to ABA
-
Not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan
-
Apply only to state-regulated insurance plans; it would not apply to self-funded insurance plans which are regulated by the federal government under ERISA law
-
Take effect 120 days after enactment
|
