North Carolina Autism News:
 AUTISM SPEAKS ENDORSES NORTH CAROLINA AUTISM INSURANCE REFORM BILLS
S.1265/H.1897 Would End Health Care Discrimination Against Children With Autism by Requiring Coverage of Diagnosis and Treatment
NEW YORK, NY (May 20, 2010) – Autism Speaks, the nation’s largest autism advocacy organization, today announced its support for Senate Bill 1265 and House Bill 1897, the 2010 North Carolina autism insurance reform bills. The legislation would require private health insurance companies to cover the screening, diagnosis, testing and treatment of autism spectrum disorder (ASD).
Sponsored in the Senate by State Senator William R. Purcell and in the House by Representative Bob England, M.D., S. 1265/H. 1897 includes coverage up to $75,000 per year for behavioral health treatments, such as Applied Behavior Analysis (ABA) therapy, an evidence-based, medically-necessary autism treatment.
“We applaud and thank Senator Purcell and Representative England 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.1265/H.1897 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 $75,000 per year. In the process, many risk their homes and the educations of their unaffected children – essentially mortgaging their entire futures. Nineteen states – Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Montana, Nevada, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, and Wisconsin – have passed similar autism insurance reform bills. Bills in Vermont, Missouri, and New Hampshire have been passed by the legislature and await signature into law by the governors.
Pictured above: John Burress, State Senator Linda Garrou, Lorri Unumb, Autism Speaks Senior Policy Advisor & Counsel, and Bob D'Amelio, Autism Speaks North Carolina Chapter Advocacy Chair at a recent hearing on autism insurance reform
Summary of the Autism Insurance Reform Bills:
Senate Bill 1265 - Sponsored by Senator William R. Purcell
House Bill 1897 - Sponsored by Representative Bob England, M.D.
- 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 these bills, 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
- 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, physical therapists, or social workers
- 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, state employee health plans (including the State Health Plan for Teachers). 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, 2011
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