Wisconsin

Wisconsin Autism News:

News Release From the Office Wisconsin's Office of the Commissioner of Insurance: Governor Doyle Announces Implementation of Autism Coverage

(October 19, 2009) Madison, WI—Governor Jim Doyle today announced an emergency rule implementing new provisions in state law requiring insurance coverage of autism spectrum disorders.

"We have worked long and hard for this day, and I am thrilled that children across the state living with autism will now have access to the care and support they need and deserve," Governor Doyle said. "We are also helping take the squeeze off the hardworking families that support these children."

"Starting November 1, 2009, insurance companies are required to cover treatment for autism spectrum disorders," stated Wisconsin Insurance Commissioner Sean Dilweg. "I appreciate the work done by OCI's Autism Treatment Working Group to assist in developing the emergency rule implementing the statute." The diverse working group was composed of parents, providers, insurers, patient advocates, and representatives from the Wisconsin Department of Health Services.

The new law requires OCI to, by rule, define terms for intensive level services, nonintensive level services, qualified, and paraprofessionals. It also addressed education, both professional and specific training with individuals diagnosed with autism spectrum disorders, necessary to be considered qualified to provide treatment. The full text of OCI's emergency rule can be found at OCI's Web site at oci.wi.gov/rules/0336em09.pdf.

The emergency rule is not applicable to employers who operate self-funded health plans. The state can only require autism coverage for a health insurance policy issued by an insurer. The emergency rule will remain in effect for one year. OCI is working on a permanent rule to replace the emergency rule.

Featured Wisconsin Headlines:

Autism Speaks Applauds Wisconsin Legislature And Governor Jim Doyle For Enacting Autism Insurance Reform Through The Budget Bill (June 30 , 2009)

Autism Speaks Endorses Wisconsin Autism Insurance Reform Legislation(February 19, 2009)

Summary of Autism Insurance Reform Law in Wisconsin:

The bill was championed by State Senator Judy Robson (D-15) and Representative Kim Hixon

• Requires private health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder
  
  
• Under this bill an insured individual can receive coverage of at least $50,000 annually for intensive-level services (with a minimum of 30-35 hours of care) per week for four years
  
  
• The bill defines "Intensive-level services" as "evidence-based behavioral therapy that is designed to help an individual with autism spectrum disorder overcome the cognitive, social, and behavioral deficits associated with that disorder" - this included Applied Behavior Analysis (ABA) therapy 
  
  
  
• After the four year intensive-level services period is up, an insured can receive coverage of at least $25,000 annually for post-intensive-level services
  
  
• The bill defines "Post-intensive-level services" as "therapy that occurs after the completion of treatment with intensive-level services and that is designed to sustain and maximize gains made during treatment with intensive-level services or, for an individual who has not an will not receive intensive-level services, therapy that will improve the individual's condition"
  
  
• Under this bill, the commissioner must further define "intensive-level services" and "post-intensive-level services"
  
  
• Coverage of treatments will be provided  when prescribed by a licensed physician and  provided, to an individual diagnosed with autism by a licensed pschiatrist, psychologist, or social worker, or a paraprofessional working under the supervision of any of these three types of providers.
  
   
• Coverage will also be provided for the services of a professional working under the supervision of an outpatient mental health clinic, a speech-language pathologist, or an occupational therapist.
  
  
• The bill applies only to fully-funded individual and group health plans governed by state law and to state, county, city, town, village, and school district health plans offered to public employees