Excerpt from SPECTRUM Magazine ... article by Elizabeth McBreen

MARCH 2010  Fifteen states now mandate insurance coverage of autism services

As the federal government battles over national health care reform, advocacy groups around the country continue working towards passing state insurance mandates. Fifteen states now have laws mandating the coverage of autism services. Another 30 have introduced or re-introduced bills this year and are hoping to join the states with coverage. Taking on the powerful insurance lobbies is difficult in good times, and with some states still reeling in the aftermath of the economic downturn, convincing state legislatures to pass mandates has become even more challenging.

Missouri
Missouri residents are also hoping this is the year that lawmakers pass a mandate. Last year, which was the second time an insurance bill had been introduced, the bill was passed by the Senate but defeated in the House when Missouri’s representatives decided the timing was not right for an insurance mandate. Parents and advocates used the time between sessions to keep talking about the issue and build momentum for the bill’s third round through the House and Senate. So far, the bill has passed floor votes in both chambers, showing a wide base of support.
Rebecca Fehlig is the executive director of the St. Louis Chapter of Autism Speaks. She says that the centerpiece of the bill is Applied Behavior Analysis (ABA). “This is not to say that it’s the only treatment, but ABA is evidence-based, it’s the most commonly denied, and it is extremely expensive.”

The bill will most likely have a dollar cap of between $36,000, the current cap in the House bill, and $55,000, the current cap in the Senate bill, and an age limit of 18 years, according to parent advocate Ginger Luetkemeyer. Any age cap is not ideal says Luetkemeyer, “but the insurance companies wanted to narrow the parameters on the bill, and they have been successful in some cases.” The bill was originally filed with no caps, but the Senate made the concession to the insurance companies to keep the bill in play. “Unfortunately, that is the necessity of getting something passed. While we hate it, it’s better to have coverage and be able to repeal an age cap later.”

One of the tactics the insurance lobby has used in Missouri is to make language on the licensure process of behavioral analysts necessary. Missouri families are against stringent language that could severely limit the amount of people who qualify for a license to practice ABA. The House bill currently includes licensure language, while the Senate has held off.
Luetkemeyer says there is no indication of major roadblocks for the bill at this point. The questions that remain are what the final bill will cover, the cost of the bill, and whether small businesses will be covered. Currently, both bills include language that would cover them, but there is an opt-out clause if the business can prove financial loss due to the coverage.

 

February 16, 2010

St. Louis Post Dispatch:   The Missouri House gave initial approval tonight to a bill requiring insurance companies to pay for up to $36,000 a year in behavioral therapy for children with autism.

Republican leaders said the bill reflected a “delicate balance” between those needing coverage and those worried that a mandate would increase health insurance costs.

Last year, autism legislation died in the House when leaders didn’t let it come to a vote. After harsh criticism from Gov. Jay Nixon, Speaker Ron Richard, R-Joplin, promised the bill would be the first debated this year.

Democrats said Tuesday that while they were glad the bill finally reached the House floor, it was the tenth measure debated, not the first.

Richard told reporters that he had moved the bill as quickly as possible.

“The fact is, you’ve got these kids who are sick and need help,” he said. “They don’t care if it’s first, as long as it gets done.”

It’s not done yet.

Another vote is needed to send the bill to the Senate, which has given preliminary approval to a more far-reaching bill.

Autism is a brain disorder that is usually diagnosed between ages 2 and 5 and is characterized by problems with communication, social interaction and behavioral flexibility.

One-on- one therapy known as applied behavior analysis, or ABA, has proved effective in improving brain functioning, especially when treatment begins at an early age and is provided at least 20 hours a week.

“It’s not experimental,” said the bill’s sponsor, Rep. Dwight Scharnhorst, R-St. Louis County. “It’s an accepted practice.”

But most insurers don’t cover the therapy, leaving families with huge bills.

Insurers have argued that a mandate will increase premiums for everyone by up to 3 percent, forcing many employers to drop coverage. The bill’s supporters dispute those figures, saying costs have risen less than 1 percent in states that have passed mandates.

While the House plan would trigger $36,000 a year for ABA until age 18, a Senate bill would go further, requiring $55,000 a year in coverage to age 21. Differences in the two versions would have to be worked out by a House-Senate conference committee.

Scharnhorst predicted that the final bill would be closer to the Senate version.

“I’m going to get as close to that as I can get,” he told reporters. “I think I can get to $50,000.”

Both bills would let small businesses seek exemptions from the mandate if they could prove their premiums rose at least 2.5 percent in a year because of the autism coverage.

January 20, 2010

Autism coverage gains momentum in Missouri Legislature
By Virginia Young
POST-DISPATCH JEFFERSON CITY BUREAU

JEFFERSON CITY — Families with autistic children appear likely to gain insurance coverage in Missouri next year, but how much coverage will be the focus of a heated debate that kicked off Tuesday.

In jammed hearing rooms, supporters of an insurance mandate urged legislative committees to make Missouri the 15th state, including Illinois, to require that all health insurance policies pay for diagnosis and treatment of the fast-growing brain disorder.

The issue has been on the front burner since Gov. Jay Nixon, a Democrat, criticized the Republican-led House for killing the bill last year. GOP leaders have promised to make it a priority this year. To get a jump on Nixon, both the House and Senate held autism hearings on the eve of Nixon's "State of the State" speech, which he will deliver at 7 tonight and which is expected to highlight the issue.

In autistic children, the brain does not develop normally, causing an array of problems with communication and social interaction. National studies have found the disorder affects roughly one in 100 children — one in 83 in the St. Louis region, the highest rate in the country, according to an expert who testified Tuesday. 

The good news, witnesses said, is that one-on-one therapy called applied behavioral analysis, or ABA, has been successful in treating autism, especially if the therapy begins at a young age.

Half of the children treated as preschoolers will enter first grade "indistinguishable from their peers," said Lorri Unumb, senior counsel for a national group called Autism Speaks and the mother of an 8-year-old son with autism.

But the therapy is expensive, costing families tens of thousands of dollars a year, depending on the severity of the child's disorder. Treatment involves three tiers — a consultant for three to six hours a month, a supervisor for six hours a week and a therapist in the home for as much as 40 hours a week.

Insurers agreed that the therapy can improve brain functioning, but they argued that it works well only for young children — say, younger than 7. The therapy has "very limited" efficacy for older children, said Dr. Blake Williamson, a vice president and senior medical director at Blue Cross Blue Shield of Kansas City.

Insurers oppose the bill's guarantee of up to $72,000 in treatment for children and adults up to age 21. Instead, Williamson suggested a $32,000 annual benefit up to age 7, with lesser benefits after that.

But in focusing on ways to scale back the bill rather than kill it, the opponents' position showed their recognition that the measure has broad bipartisan support. 

The insurance industry generally opposes all mandates, contending that they increase costs for everyone, forcing some people to drop their coverage and some companies to quit providing insurance for employees.

Indeed, insurers said the autism mandate could raise premium costs in the state by at least 3 percent.

Advocates for the autism bills contested that point, saying that in states that require the coverage, costs have risen less than 1 percent.

However, David Smith, representing Anthem Blue Cross Blue Shield of Missouri, said those comparisons may not be valid. For example, he said that Indiana has more school programs for autistic children than Missouri does, and spends twice what Missouri does on such initiatives.

The one thing that was clear Tuesday was that Republicans and Democrats alike want to address the issue during this election year before going home to constituents who struggle with the disorder or know families who do.

Legislators heaped praise on the bills' sponsors, Rep. Dwight Scharnhorst, R-St. Louis County, and Rep. Jason Grill, D-Parkville, for bringing the bills forward. In a sign of the popularity of the issue, Rep. Rob Schaaf, R-St. Joseph, ribbed Scharnhorst for accidentally failing to list Schaaf as a co-sponsor.

While the House bills are similar, Scharnhorst's is broader, requiring $72,000 in benefits. Grill said he attempted a compromise, modeling his bill after a measure that passed the Senate last year. It would require coverage of up to $55,000 a year in treatment up to age 15.

Rep. Kevin Wilson, R-Neosho, heads the House committee that will craft a bill to send to the House floor for debate. Wilson said he wants to look at the age and benefit limits, as well as credentials required for therapists providing the service.

"We're going to be aggressive but not rush something that's not right," Wilson said.

Still up in the air: whether to exempt or provide an opt-out provision for small businesses. Some of the proposals would let businesses with 50 or fewer employees seek exemptions if they could prove their premiums would rise by at least 5 percent as a result of the autism coverage.

"I know this bill's going to pass this committee," said Brad Jones, a lobbyist for the National Federation of Independent Businesses. "I just ask we keep the small business community in mind."

December 31

December 3, 2009

Missouri lawmakers try again on autism insurance

JEFFERSON CITY, Mo. — Missouri’s top House official pledged his support for legislation requiring health insurers to cover an expensive therapy for autistic children.

Legislation proposed for the 2010 session would require group health insurance plans to cover up to $72,000 of behavioral therapy per year for autistic people under age 21. Businesses with 50 or fewer employees would be exempt if they proved the requirement would raise the cost of their premiums by at least 5 percent.

The legislation is similar to — and in some ways, broader than — legislation that passed the Senate earlier this year but never received a House vote because Speaker Ron Richard said there wasn’t a consensus.

On Wednesday, Richard joined the lead House sponsor, Rep. Dwight Scharnhorst, in a media conference call outlining the latest legislation and pledged it would be the first bill on the House calendar when the session starts in January.

“We want to help these kids and families, and we’ve committed to do that,” said Richard, R-Joplin.

Democratic Gov. Jay Nixon was to travel the state with several other lawmakers Thursday, promoting the legislation. In July, Nixon had sharply criticized Republican House leaders for not allowing a vote on the autism legislation.

“Governor Nixon is pleased that both the House and Senate have prefiled bills that meet the criteria he laid out earlier this year for successful autism insurance coverage legislation,” Nixon spokesman Jack Cardetti said.

Although consensus may be forming among top elected officials, the Missouri Insurance Coalition said Wednesday that it remains opposed to requiring autism coverage.

The 2010 legislation “sounds very expensive, sounds like a full blown mandate, sounds like special interests may get served at a very high price tag while others who are struggling to pay premiums may get priced out of the market,” insurance coalition executive director Calvin Call said.

Insurers’ lobbyists told lawmakers during the last legislative session that requiring autism coverage could raise premiums by more than 3 percent and prompt thousands of people to drop their health insurance.

An actuarial analysis by the consulting firm Oliver Wyman, conducted for the advocacy group Autism Speaks, estimated an autism insurance requirement would result in a less than 1 percent increase in the cost of premiums.

Nationally, about 1 in 150 children are diagnosed with a form of autism.

At issue is a treatment known as “applied behavioral analysis.” Some parents say it dramatically improves their children’s condition, but it costs more than $50,000 a year and is not covered by insurers in Missouri.

Fourteen states have laws requiring coverage of “medically necessary, evidence-based autism therapies” such behavioral analysis services, according Autism Speaks.

After autism legislation failed in the 2009 session, Richard appointed a House committee to continue working on the issue and Nixon held news conferences pushing for the legislation. Sens. Scott Rupp, R-Wentzville, and Eric Schmitt, R-Glendale, joined in several rallies around the state.

“Missouri families living with autism spectrum disorders — and tens of thousands more concerned citizens and supporters of autism insurance reform — have spoken loudly and clearly that our state must address this urgent matter so that families can afford the necessary diagnosis, treatment and support services,” Rupp said in a written statement Wednesday.

 October 16, 2009

 "How Dollars and Legislation Go Hand in Hand"

Article By Stee Krasky and Jason Noble of Kansas City Star

•A bill aimed at requiring insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorders easily passed the GOP-controlled Senate on a 29-2 vote and cleared two House committees.

But House leadership opted not to bring the bill to the floor, despite widespread support. Insurance companies opposing the bill followed up that decision with at least $40,000 in donations to House Speaker Ron Richard and floor leader Steven Tilley, a client of political consultant Rod Jetton.

Gov. Jay Nixon, a Democrat, was prepared to sign the measure. During the summer he complained about the bill’s defeat, saying: “The only argument is that the insurance industry didn’t want it. And that’s not an argument.”

Of the campaign donations, Nixon said: “People can draw whatever conclusions they want.”

When asked whether the contributions played into Richard’s decision not to advance the bill, spokeswoman Kristen Blanchard said: “Absolutely not.”

Despite public comments from lawmakers in support of the bill, Blanchard said, many privately expressed reservations about it — so many, in fact, that the bill’s passage was unlikely.

“When this bill came to the floor, it was not going to pass,” she said, adding that Richard “was 100 percent sure it wouldn’t pass.”

Tilley said he personally supported the bill but deferred to Richard’s decision not to place the bill on the legislative calendar for consideration.

September 10, 2009

Jefferson City – An interim committee charged with studying the impact of Autism Spectrum Disorders on Missouri families will hold its first public hearing during the week of Veto Session. Jonathan Lorenz reports from the State Capitol.

Click here to view the video feature on the House Interim Committee on Autism Spectrum Disorders.

The House Interim Committee on Autism Spectrum Disorders chaired by Rep. Dwight Scharnhorst (R-St. Louis) will take public testimony during a hearing scheduled for Tuesday, September 15 at 12 p.m. in House Hearing Room 7 in the State Capitol.

Click here for list of House Interim Committee on Autism members

August 10, 2009

Article By Tony Messenger
St. Louis Post-Dispatch

JEFFERSON CITY — It’s not just Democrat Gov. Jay Nixon who is pushing the autism insurance bill.

St. Louis area senators Scott Rupp of Wentzville and Eric Schmitt of Glendale — both Republicans — have established a Web site pushing the autism insurance coverage bill and in September will hold a public rally kicking off support for the legislation next session.

Rupp and Schmitt — who has a son with autism — were key supporters of the bill that passed the Senate last year but never received a vote in the House. Nixon pushed the bill as an early legislative priority in a state flyaround last week.

Meanwhile, House Speaker Ron Richard, R-Joplin — who never put the bill on the calendar last year — is criticizing Nixon for politicizing the issue. Richard has appointed an interim committee to study the issue of mandating autism insurance. The committee hasn’t met yet.

Rupp and Schmitt’s rally is on noon on Sept. 20 at The Meadows at Lake St. Louis.

July 17
MO House News

Jefferson City – Missouri House Speaker Ron Richard, R-Joplin, announced the creation of an Interim Committee on Autism Spectrum Disorders. This committee is charged with the responsibility of reviewing and making recommendations on issues pertaining to the regulation of insurance and other matters impacting the lives of those diagnosed with Autism.

“We have spent months gathering facts and researching what answers are most effective in aiding Missourians with Autism,” said Speaker Richard. “I am tasking the members of the Interim Committee on Autism Spectrum Disorders with finding a responsible, effective solution that all sides can agree on,” he finished.

Richard named Rep. Dwight Scharnhorst, R-St. Louis, to chair the committee. As Chairman, Scharnhorst is given the responsibility of directing committee meetings and ensuring that all members work together to find a meaningful legislative solution to the growing Autism epidemic.

“Representative Scharnhorst has been an advocate for Autism in the past and I am confident that he will continue to be a strong leader on the issue moving forward,” said Speaker Richard.

“I thank Speaker Richard for his dedication to this matter and for asking me to chair the Interim Committee on Autism Spectrum Disorders. Our members will work together to review the facts and produce progressive measures that will improve the lives of Missouri families who deal with Autism. I am confident that through this interim committee, we will be able to move closer to a definitive solution.” said Representative Scharnhorst.

The interim committee will hold hearings in the coming weeks.

In addition to Rep. Scharnhorst, the committee is made up of the following members:

Representative Wayne Cooper, Vice Chairman
Representative Sue Allen
Representative Ron Casey
Representative Mike Colona
Representative Sally Faith
Representative Jeff Grisamore
Representative Denny Hoskins
Representative Tishaura Jones
Representative Shelley Keeney
Representative Michele Kratky
Representative Chris Molendorp
Representative Gina Walsh
Representative Terry Witte

July 8, 2009
Capitol Calling

Nixon bashes House for not passing autism insurance bill
On a day where Gov. Jay Nixon signed a number of bills on a number of different subjects, it was legislation that failed to pass that rankled the first-term Democratic governor the most.

While the Senate passed legislation mandating insurance companies to cover ailments related to autism disorder, the House failed to act on the last day of session. It was cited by Nixon as one of the chief disappointments of the legislative session.

How rankled was Nixon? Judge for yourself! 

WATCH THE VIDEO!

May 27, 2009

KC Star:  After catching flak for House inaction on a bill requiring insurance companies to cover autism, House Speaker Ron Richard promised Wednesday to bring all the sides together this summer and file a bill next winter.

"I have instructed several of my chairman to work to compose a plan that will bring insurance companies and autism advocacy groups together for a compromised solution to this very real problem," Richard, a Joplin Republican, said in a statement.

He also said: "Missourians can expect a solid health-care plan, covering autism patients and uninsurable Missourians, mid-summer and expect a bill to be filed in December and taken up on the floor in the coming Legislative Session."

The comments come a day after two Republican senators decried in a St. Louis Suburban Journals article the House's refusal to take up an insurance-coverage bill before the legislative session ended May 15.

One of the senators, Scott Rupp, of Wentzville, blamed "House leadership" for the bill's failure

 April 6, 2009 

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