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Autism Insurance Advocates Look to 2011

April 6, 2010

By Alli Atayee
Capital News Service

RICHMOND – Parents of autistic children must wait until next year to see if Virginia will require health insurers to cover treatment for their youngsters.

During the legislative session that ended last month, the General Assembly considered three bills requiring insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder. As in past years, all of the bills failed.

“We wanted to get as much help as we could for these families who get no financial assistance when treating their child’s medical diagnosis of autism,” said Teresa Champion, director of the Northern Virginia chapter of the Autism Society of Virginia.

Representatives of the society and Autism Speaks, a national advocacy group, tried to compromise with state lawmakers. Those concessions were reflected in Senate Bill 464, sponsored by Sen. Janet Howell, D-Reston.

SB 464 would have required insurance companies to cover autism treatment for children only from age 2 to 6, with an annual maximum benefit of $35,000. Howell’s bill would “not apply to an insurer, corporation or health maintenance organization if the costs associated with coverage exceed 1 percent of premiums charged over the experience period.”

Moreover, SB 464 would not have applied to individual or small-group plans, and it would not have applied to state employees’ health insurance plan until July 1, 2015.

Howell urged legislators to assist families struggling with autism.

“These families and these children are desperate for services that we don’t provide them. These kids truly need our help, and this limited bill will give them some needed assistance,” Howell said.

The Senate voted 27-13 for Howell’s bill. However, it was tabled in the House Commerce and Labor Committee and died there when the General Assembly adjourned on March 14.

Sen. George Barker, D-Alexandria, voted against SB 464 in the Senate. He said that he has worked on the autism issue for many years and that he favors comprehensive legislation that would provide full services for people starting as young as possible.

“I’m not comfortable with this bill because it only served a narrow window of children,” Barker said.

He said Howell’s bill would have applied to only 15 percent of the families who need autism insurance. “Eighty-five percent would be left uncovered,” Barker said.

Bills mandating a more comprehensive approach also failed during the legislative session. Besides SB 464, lawmakers considered:

  • House Bill 34, sponsored by Delegate Bob Marshall, R-Manassas. It would have required insurers “to provide coverage for the diagnosis and treatment of autism spectrum disorder in individuals under age 21.” Marshall’s bill never made it out of the House Commerce and Labor Committee.
  • HB 303, by Delegate John O’Bannon, R-Henrico. It would have required insurers to cover autism treatment “in individuals from the date of diagnosis until they reach 10 years of age. This requirement does not apply to individual or small group policies, contracts, or plans, and will not apply to the state employees’ health insurance plan until July 1, 2015.” O’Bannon’s bill died in the same House committee.

Champion said Howell’s bill would have been a move in the right direction.

“This is a bill that is a step towards helping families who have no resources to pay for these therapies,” Champion said. “It isn’t as broad as it could be, but we’ve compromised to show and do something to show that this is not going to break the bank.”

Autism insurance advocates are frustrated that the General Assembly has rejected both comprehensive coverage and more-limited coverage.

“I don’t know what we can do about that other than shine the light of day on it and say, ‘We’ve done everything we possibly can to accommodate your concerns about this bill,'” Champion said.

“The question is, What bill would they pass?”

According to Autism Speaks, autism affects more than 1.5 million Americans, including 75,000 Virginians.

The group’s Web site said that last week, Iowa, Kansas and Kentucky all passed autism insurance reform bills. As a result, 18 states now require health insurance companies to provide coverage for autism treatment.


On the Web

Autism Speaks: www.autismspeaks.org

Autism Society of America: www.autism-society.org

Autism Society of America – Central Virginia Chapter: www.asacv.org