North Carolina Autism News:
Autism Speaks Endorses North Carolina Autism Insurance Reform Bill
Senate Bill 115 Would End Health Care Discrimination Against Children
with Autism by Requiring Coverage of Diagnosis and Treatment
NEW YORK, NY (MARCH 18, 2011) – Autism Speaks, the nation’s largest autism advocacy organization, today announced its support for S. 115, an autism insurance reform bill, in the state of North Carolina. The legislation would require private health insurance companies to cover the diagnosis and treatment of autism spectrum disorder (ASD) for individuals with the disorder.
Sponsored in the North Carolina Senate by Senator William Purcell (District 15), as well as Senators Linda Garrou (District 32), Eric Mansfield (District 21) and Robert Atwater (District 18), S. 115 includes coverage of behavioral health treatments, such as Applied Behavior Analysis (ABA), an evidence-based autism therapy. Behavioral therapies would be limited to $75,000 per year.
“We applaud and thank Senators Purcell, Garrou, Mansfield and Atwater for their leadership on this issue of critical concern to thousands of North Carolina families,” said Peter Bell, Autism Speaks executive vice president for programs and services. “Autism Speaks joins North Carolina’s autism community in calling on the legislature to pass S. 115 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.
Twenty-four – Arizona, Arkansas, Colorado, Connecticut, Florida, Iowa, Illinois, Indiana, 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 vote on similar legislation during the 2011 session.
Autism Speaks Endorses North Carolina Autism Insurance Reform Bills (May 20, 2010)
Summary of the Autism Insurance Reform Bills:
Senate Bill 115 - Sponsored by Senator William R. Purcell
House Bill 826 - Sponsored by Assemblymembers Parfitt, Glazier, Keever and Murray
- 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 or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist in accordance with a treatment plan
- 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
- Behavioral care - meaning any practices for the purpose of increasing appropriate or adaptive behaviors, decreasing maladaptive behaviors, developing, maintaining, or restoring, to the maximum extent practicable, the functioning of an individual, including the systematic management of environmental factors or the consequences of behaviors. Coverage is provided when behavioral care is provided or supervised by a state-licensed or state-certified health care professional.
- Pharmacy care - meaning medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need for or effectiveness of the medications
- Psychiatric care - meaning direct or consultative services provided by a licensed psychiatrist
- Psychological care - meaning direct or consultative services provided by a licensed psychologist or licensed psychological associate
- Therapeutic care - meaning services provided by licensed or certified speech language pathologists, occupational therapists, or physical therapists
- The bill provides coverage for comorbid biomedical conditions
- Coverage for behavioral therapy under these bills will be subject to a maximum benefit of $75,000 per year
- 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 and the state employee health plans. It does not apply to self-funded insurance plans, as these plans are regulated by the federal government under ERISA law
- Coverage would begin for state regulated plans that are delivered, issued, continued, or renewed on or after January 1, 2012
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