Vermont

Vermont Autism News:

Autism Speaks Endorses Vermont Autism Insurance Reform Bill

S. 262 Would End Health Care Discrimination Against Children with Autism by Requiring Coverage of Diagnosis and Treatment

NEW YORK, NY (January 13, 2010) – Autism Speaks, the nation’s largest autism advocacy organization, today announced its support for S. 262, the Vermont autism insurance reform bill. The legislation would require private health insurance companies to cover the screening, diagnosis, testing and treatment of autism spectrum disorder (ASD).

Sponsored in the Vermont State Senate by State Senators William Carris and John Campbell, S. 262 includes coverage of behavioral health treatments, such as Applied Behavior Analysis (ABA), an evidence-based, medically-necessary autism therapy.

“We applaud and thank Senators Carris and Campbell for their leadership on this issue of critical concern to thousands of Vermont families,” said Peter Bell, Autism Speaks executive vice president for programs and services. “Autism Speaks joins Vermont’s autism community in calling on the legislature to pass S. 262 and join the growing number of states that have ended healthcare discrimination against children with autism.”

Most 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.

Fifteen states – Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Montana, Nevada, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, and Wisconsin – have enacted autism insurance reform legislation. Several other state legislatures will vote on similar legislation during the current 2010 session.

Summary of Vermont Autism Insurance Reform Bill (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
  
  
• 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
  
  
• The term "medically necessary" is defined in the bill as "any care, treatment, intervention, service, or item that is prescribed, provided, or ordered by a licensed physician or by a licensed psychologist pursuant to if such treatment is consistent with the most recent, relevant report or recommendations of the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, or another professional group of similar standing"
  
  
• Under this bill, 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 bill 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 bill 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
  
  
• If enacted, this bill would take effect on October 1, 2010