Massachusetts

Massachusetts Autism News:

Autism Speaks, State Representative L’italien, AFAM Join Massachusetts Autism Community In Applauding The House For Passing H. 4935

MA Could Become the Twenty-Third State in the Country to Require Insurance Coverage of Autism Therapies

NEW YORK, NY (July 28, 2010) -- Autism Speaks, State Representative Barbara L’Italien, and Advocates For Autism of Massachusetts (AFAM) joined parents of children with autism and other autism advocates late yesterday in applauding the members of the state House of Representatives for their passage of House Bill 4935 (formerly H. 3809), which requires insurance companies to provide coverage of evidence-based, medically necessary autism therapies, such as applied behavior analysis.

The bill, which is sponsored in the House by State Representative L’Italien (18th Essex District), Vice Chair of Ways and Means, and in the Senate by Majority Leader Frederick Berry (2nd Essex District), would end private insurance companies’ discrimination against children with autism by requiring coverage of medically necessary autism treatments, including evidence-based behavioral health treatments. The bill has been endorsed by Boston Mayor Tom Menino, the Arc of Massachusetts, and the Massachusetts Developmental Disabilities Council. Under H.4935, there are no age or dollar caps on benefits.

“Autism Speaks applauds the members of the Massachusetts House for their passing of House Bill 4935 thereby extending a helping hand to families that have been financially devastated by the lack of insurance coverage for necessary autism therapies,” said Peter Bell, Autism Speaks executive vice president of programs and services. “We now call on the members of the Senate to follow suit and pass this bill, allowing Massachusetts to join the ranks of states that have recognized the unfair and unreasonable burden being imposed on families of children with autism.”

“Today is a historical day in Massachusetts, following in the footsteps of other states that have implemented autism medical insurance coverage,” said Representative L’Italien. “Experience data in Minnesota show that Blue Cross and Blue Shield have been covering autism services for six years at 83 cents per person per month. I am proud of my House colleagues for passing the Autism Insurance bill, striving to make Massachusetts the 23rd state to provide coverage for persons with Autism. We have taken steps to transform lives today by providing services and treatments to all individuals on the spectrum, not just those that can struggle to afford it or who fall under the protection of the Commonwealth.”

Most states do not require private insurance companies to cover even essential autism treatments. 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.

“We are pleased to have passed to have passed this major hurdle, which will bring people in Massachusetts affected by autism the systemic change that is so essential to accessing treatment,” said Amy Weinstock, Chair of the AFAM Insurance Working Group.

Massachusetts could become the twenty-third state to enact an autism insurance reform law. So far, twenty-two states – Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, Vermont, and Wisconsin -- have enacted this legislation.  

Autism Speaks, State Representative L’italien, AFAM Join Massachusetts Autism Community In Calling For An End To Autism Insurance Discrimination (October 21, 2010)

Autism Insurance Reform Bill Introduced in Massachusetts (January 22, 2009)

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Summary of the Autism Insurance Reform Bill in Massachusetts

House No. 4935 (ARICA - An Act Relative to Insurance Coverage for Autism) - Sponsored by State Representative Barbara A. L'Italien (D-42) and State Senator Frederick Berry (D-7) 

• Requires private health insurance companies to provide coverage for the diagnosis and treatment of  autism spectrum disorder
  
  
• 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 bill includes coverage of the following treatments: Habilitative or rehabilitative care, Pharmacy care, Psychiatric care, Psychological care, Therapeutic care, Applied Behavior Analysis (ABA)
  
  
• There are no dollar or age caps on benefits
  
  
• The bill contains a three year opt out provision for health insurance plans if they can prove that providing coverage of ABA has increased their premiums by more than 1%
  
  
• The bill does not affect educational services provided under IFSP, IEP, or ISP
  
  
• The bill applies only to fully-funded health plans governed by state and to state health plans offered to public employees
  
  
• Potential savings not only would be realized by families affected by autism, but also by the Commonwealth:
  • Approximately $7 million in reduced Early Intervention costs to DPH. (Note: despite the recent changes to EI legislation increasing insurance reimbursement limits for EI, specialty services are not covered and continue to remain obligations of the State).
  • Reduced Special Education costs. (Studies indicate that 20-50% of the students with ASD who receive appropriate intervention are able to participate in regular education classes, indistinguishable from their peers. 90% show improvement, which also reduces the level of special education support needed.)
    
    
• According to a 2007 study conducted by the Harvard School of Public Health, the estimated cost of caring for a person with Autism Spectrum Disorder over their lifetime is $3.2 million. Insurance coverage for evidence-based treatment is the fiscally responsible thing to do.