Massachusetts

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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. 3809 (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)
  
  
• 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
  
  
• Estimated mid-range claim cost per covered person would be $27.40 annually, or approximately $2.28 per month (according to the Oliver Wyman independent actuarial analysis prepared May 2009). It should be noted that costs would likely phase in over a multi-year period as the bill is implemented
  
  
• 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.