Washington

Washington Autism News:  

Court Finds Washington State Health Care Authority Violates Mental Health Care Parity Act

Blanket Exclusion of ABA Ruled Illegal

SEATTLE, WA (June 7, 2011) -- Autism Speaks representative Arzu Forough takes part in successful class action suit  testing Washington state's landmark Mental Health Parity Act. Read more.....

Autism Speaks Endorses Washington State Autism Insurance Reform Bill

“Shayan’s Law” Would End Health Care Discrimination Against Children with Autism by Requiring Coverage of Diagnosis and Treatment

NEW YORK, NY (January 21, 2011) – Autism Speaks, the nation’s largest autism advocacy organization, today announced its support for Senate Bill 5059, also known as “Shayan’s Law,” the autism insurance reform bill. The legislation would require private health insurance companies to cover the diagnosis, testing, and treatment of autism spectrum disorder (ASD).

Sponsored in the Washington State Senate by State Senator Ed Murray (District 43), SB 5059 includes coverage of behavioral health treatments, such as Applied Behavior Analysis (ABA), an evidence-based, medically-necessary autism therapy. The bill has been referred to the Senate Committee on Health & Long-Term Care, which will hold a hearing on Monday, January 24, 2011.

“We applaud and thank Senator Murray for his leadership on this issue of critical concern to thousands of Washington State families,” said Peter Bell, Autism Speaks executive vice president for programs and services. “Autism Speaks joins Washington’s autism community in calling on the legislature to pass Shayan’s Law 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.

To date, twenty-three states – Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, 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 introduce similar legislation during the current 2011 session.

Autism Insurance Bill Introduced in Washington State (January 19, 2009)

Summary of 2011 Washington Autism Insurance Reform Bill:

Senate Bill 5059 (Shayan's Law) - Sponsored by State Senator Ed Murray (43rd district)

Would require health insurance companies to provide coverage of the screening, diagnosis and treatment of autism spectrum disorders


• A health care plan may not terminate coverage, or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an enrollee solely because the individual is diagnosed with, or has received treatment for, an autism spectrum disorder
  
  
• The bill has no cap on age or number of visits
  
  
• The bill has no annual benefit dollar limit
  
  
• The bill requires that coverage not be subject to lifetime maximums, deductibles, copayments, or coinsurance or other terms and conditions that are less favorable than those that apply to physical illness generally under the health plan
  
  
• 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 bill, health insurance companies would be required 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 services and treatment programs, including behavioral intervention therapy, applied behavioral analysis (ABA), and other intensive behavioral programs, that have demonstrated efficacy to develop, maintain, or restore, to the maximum extent practicable, the functioning or quality of life of an individual and that have been demonstrated to treat the core symptoms associated with autism spectrum disorder
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care - meaning services provided by licensed or certified speech therapists, occupational therapists, or physical therapists
  • Any care for individuals with autism spectrum disorders that is demonstrated, based upon practices or evidence-based research, to be medically necessary
    
    
• 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