Mo. House endorses bill mandating autism insurance

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by The Associated Press

KMOV.com

Posted on February 16, 2010 at 9:30 PM

Updated Tuesday, Feb 16 at 9:40 PM

JEFFERSON CITY, Mo. (AP) -- A mandate for insurers to cover treatment for autistic children won initial approval Tuesday night in the Missouri House -- a year after a similar bill was stifled because of concerns it could result in higher insurance premiums.

The House legislation would require group insurance policies regulated by the state to cover up to $36,000 annually of behavioral therapy for autistic children age 18 and younger. But it is not as expansive as a Senate version, nor as some advocates for autistic children had hoped.

The autism insurance mandate would apply to about one-fourth of Missouri's population -- mainly those receiving health insurance from small- to medium-sized employers. Large employers who insure themselves are federally regulated, and people with individual insurance policies would have an option -- but not a requirement -- to buy policies with autism coverage.

Autism is a broad term used to describe a spectrum of neurological disorders that affect about 1 out of 110 children in the United States, according to the federal Centers for Disease Control and Prevention.

At issue in the Missouri legislation is how much coverage should be offered -- and how long it should last -- for those seeking "applied behavioral analysis," an intensive and costly therapy some parents say produces dramatic improvements in their autistic children.

A separate Senate bill that won initial approval earlier this month would provide up to $55,000 annually of the behavioral treatment for people until age 21. Advocates for autistic children have lobbied for a mandate to cover up to $72,000 annually up to age 21.

Both the House and Senate bills would allow businesses with 50 or fewer employees to get an exemption from the autism insurance mandate if they can show it caused their premiums to rise by at least 2.5 percent compared to the previous year.

The projected cost increase to insurance premiums has been disputed by the insurance industry and health-care advocates.

An actuarial analysis last year by the consulting firm Oliver Wyman -- which was funded by the advocacy group Autism Speaks -- estimated that an autism insurance requirement would result in a less than 1 percent increase in the cost of premiums in Missouri. But a lobbyist for Anthem BlueCross BlueShield of Missouri testified last month that premiums could rise by about 3 percent under the legislation favored by advocates.

This is the second year autism insurance has been a top issue in the Missouri Legislature.

Last year, the Senate passed a bill requiring behavioral therapy coverage of up to $55,000 annually for autistic children younger than 15. But that bill never received a House vote, because Speaker Ron Richard said there wasn't a consensus among health care providers, children's advocates and insurers.

Gov. Jay Nixon criticized the House for failing to take action. Richard appointed a committee to continue studying the issue after the 2009 session and pledged it would be the first item on the House debate calendar in 2010. It was not. But it still reached the House floor relatively early in the session.

"You got these kids who are sick and parents who need help -- they don't care if it's first or last, as long as it gets done," Richard said after Tuesday's vote.

Besides the insurance coverage amounts, there are several other differences between this year's House and Senate versions of the legislation. The Senate's insurance mandate would begin Aug. 28 while the House version would begin Jan. 1. The House legislation also would set up a state licensing process for behavior analysts and their assistants who oversee the treatment of autistic children.

(Copyright 2010 by The Associated Press. All Rights Reserved.)

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