Oregon

Oregon Autism News:

Autism Speaks Announces First State Autism Insurance Bill Endorsement Of 2011

Oregon HB 2214/SB 555 Would End Health Care Discrimination Against Children with Autism by Requiring Coverage of Diagnosis and Treatment

NEW YORK, NY (January 10, 2011) – Autism Speaks, the nation’s largest autism advocacy organization, today announced its support for House Bill 2214/Senate Bill 555, the autism insurance reform bill. The announcement marks Autism Speaks’ first state autism insurance reform bill endorsement of the 2011 legislative session and a continuation of the organization’s three year effort to end insurance discrimination against individuals with autism. The Oregon legislation would require private health insurance companies to cover the screening, diagnosis, testing and treatment of autism spectrum disorder (ASD).

Sponsored in the Oregon State House of Representatives by State Representatives Peter Buckley (District 5) and Jim Thompson (District 23) and in the Senate by State Senators Chris Edwards (District 7) and Suzanne Bonamici, HB 2214/SB 555 includes coverage of behavioral health treatments, such as Applied Behavior Analysis (ABA), an evidence-based, medically-necessary autism therapy. The bill also requires coverage of augmentative communication devices and other assistive technology devices.

“We applaud and thank Representatives Buckley and Thompson and Senators Edwards and Bonamici for their leadership on this issue of critical concern to thousands of Oregon families,” said Peter Bell, Autism Speaks executive vice president for programs and services. “Autism Speaks joins Oregon’s autism community in calling on the legislature to pass HB 2214/SB 555 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-three states – Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, 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 introduce similar legislation during the current 2011 session.

Autism Speaks Endorses Oregon Autism Insurance Reform Bill (March 31, 2009)

Summary of 2011 Oregon Autism Insurance Reform Bills:

House Bill 2214 - Sponsored by State Representatives Peter Buckley (District 5) and Jim Thompson (District 23)

Senate Bill 555 - Sponsored by State Senators Chris Edwards (District 7) and Suzanne Bonamici (District 17)

The bills would: 

• require providers of state-regulated insurance plans to provide coverage for the diagnosis and treatment of individuals with autism spectrum disorders who are under the age of 18
  

• place no dollar cap on the annual benefit, although the Senate’s version of the bill as amended would limit ABA therapy to children under age 11, up to a maximum of 87 hours per month

• require health insurance providers cover all tests, assessments, and evaluations that are necessary to diagnose autism spectrum disorder including neuropsychological evaluations, genetic testing, and other tests required for accurate diagnosis

• require coverage, following a determination of medical necessity by a licensed physician or psychologist, to include:
  • habilitative or rehabilitative care necessary to develop,  improve, maintain, and restore to the maximum possible extent an individual’s functioning, including professional counseling and treatment programs such as applied behavior analysis (ABA), developmental approaches, and other behavioral health treatments 
  • pharmacy care
  • psychiatric care
  • psychological care
  • therapeutic care, which is defined as services provided by licensed or certified speech language pathologists, occupational therapists, or physical therapists
  • augmentative communication devices and other assistive technology devices
  • coordination of care services
  • other care deemed medically necessary and that meets the standards of evidence required for coverage of other prevailing medical or surgical treatments
    
    
• not apply to self-funded insurance plans since those plans are regulated by the federal government under ERISA