Vermont

Vermont Autism News:

February 1 Update

Autism Speaks Endorses Vermont Bills Lifting Age 6 Cap on Autism Insurance Benefits

New Bills Would Expand 2010 Autism Insurance Reform Law

NEW YORK, NY (February 1, 2012) --  Autism Speaks, the world’s largest autism science and advocacy organization, today announced its support for H.736 and S.223,  which would amend Vermont’s 2010 autism insurance reform law by lifting the age 6 cap for receiving benefits. Families paying thousands of dollars a year in insurance premiums would be able to continue coverage for the screening, diagnosis, testing and treatment of autism spectrum disorder (ASD) for individuals after age 6 if the legislation is enacted.

Sponsored in the Vermont State House of Representatives by Rep. Jason Lorber (D-Burlington) and in the Senate by Sen. Anthony Pollina (D-North Middlesex), the bills would raise the age cap for coverage of behavioral health treatments, such as Applied Behavior Analysis (ABA), an evidence-based autism therapy. The House bill would raise the age cap to 22; the Senate bill would set no cap.

“We applaud and thank Representative Lorber and Senator Pollina for their leadership on this issue of critical concern to thousands of Vermont families,” said Lorri Unumb, Autism Speaks vice president for state government affairs. “Autism Speaks joins Vermont’s autism community in calling on the legislature to pass this legislation and finish the job it started in 2010 by passing its current autism insurance reform law.”

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.

A majority of states (29) representing 70 percent of the United States population have enacted autism insurance reform legislation. Similar bills are before legislatures in other states this year.

Autism Speaks Joins the Vermont Autism Community In Applauding the State LegislatureFor Passing Autism Insurance Legislation (May 7, 2010)

Autism Speaks Endorses Vermont Autism Insurance Reform Bill (January 13, 2010)

Summary of 2012 Vermont Autism Insurance Reform Expansion Bills:

H. 736 - Sponsored by Representative Jason Lorber (D-Burlington)
S.223 - Sponsored by Senator Anthony Pollina (D-North Middlesex)

• Expands the age cap by requiring state regulated private health insurance plans to provide coverage of the diagnosis and treatment of autism spectrum disorders for individuals between the ages 6 and 22 (H.736). S.223 would eliminate any age cap  
  
  
• Expands the 2010 law to require that Medicaid, the Vermont health access plan, and any other public health care assistance program provide coverage for the diagnosis and treatment of autism between the ages of 18 months and 6, or the first grade, whichever occurs first
  
  
• Expands the definition of autism treatments to include behavioral health treatment - meaning professional guidance services and treatment programs, including applied behavior analysis provided or supervised by a nationally board-certified behavior analyst, that are necessary to develop, maintain, and restore to the maximum possible extent an individual's functioning

Summary of 2010 Vermont Autism Insurance Reform Law:

S. 262 - Sponsored by State Senator William Carris and State Senator John Campbell

• Would require health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders for children with autism between the ages of 18 months and 6 years old
  
  
• Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary
  
  
• Under this law, health insurance companies would be required to provide coverage of the following:
  • Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing, or other testing to determine whether an individual has one or more autism spectrum disorders
  • Habilitative or rehabilitative care - meaning professional counseling, guidance, services, and treatment programs, including applied behavior analysis (ABA) and other behavioral health treatments, that are necessary to develop, maintain, and restore to the maximum possible extent an individuals functioning
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care - meaning services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists, or social workers
    
    
• The law requires a study of autism insurance reform for children with autism over the age of 6 years
  
  
• The law does 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
  
  
• The law applies only to state regulated insurance plans.  It does not apply to self-funded insurance plans as these plans are regulated by the federal government under ERISA law