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Autism Insurance Reform Initiatives 2011

01/31/11
by Wrightslaw

The issue of insurance covering ABA therapy for children with autism is a big issue for families in many states and for military families moving from state to state.

Although some private insurance companies will pay for a diagnosis, many insurance companies do not pay for treatment. Nationwide initiatives are underway to change state insurance laws for private health insurance .

For military families, Dept of Defense is now claiming that ABA therapy is not proven to be “medically or psychologically necessary” – the reason TRICARE,  DOD’s insurer, does not pay for the care. Military families have now filed a motion for an injunction to mandate Tricare coverage of ABA therapy.

More about autism anti-discrimination legislation...

Military Families Seek Injunction Against Department of Defense to mandate that TRICARE cover medically necessary care needed by children with autism.  Berge v. United States of America, et al., No.10-cv-00373-RBW (D.DC) – complaint.

http://www.nbc12.com/Global/story.asp?S=13902678

Other families with private insurance are faced with making the decision to move in order to get adequate coverage for treatment of a child with autism. In September, we posted on our Wrightslaw Facebook page about families moving to states where autism anti-discrimination legislation had been passed.  This legislation compels insurance companies to cover ABA treatment for children with autism.

The first comment posted on our FB link asked “What’s the best state for autism treatment?” This question was followed by comments from families who have moved in search of both appropriate autism therapy and adequate insurance coverage.

State legislation and insurance reform initiatives vary across the country.

Supported by many parents, some parents are afraid stringent insurance requirements could prevent coverage of certain therapies. Others fear these reforms would increase health insurance premiums for everyone.  State officials are also concerned about possible increased financial burden.

Twenty-three states have so far passed legislation to end insurance companies’ discrimination against people with autism.

When we posted the FB article in September, a controversial version of the bill for NY was on Gov. David Paterson’s desk.  In October 2010, although approved by the legislature, Gov. Paterson vetoed the bill.

Governor Paterson is only the second governor in the United States to veto such legislation. South Carolina Governor Mark Sanford  vetoed such legislation in June, 2007, but the S.C. legislature later overrode Sanford’s veto and Ryan’s Law was enacted.

Only 3 states (Oklahoma, Utah, Wyoming) are not currently pursuing autism insurance reform.

Find out what’s happening in your state.

Autism Votes, an Autism Speaks initiative for state autism insurance reform has a state by state analysis of anti-discrimination legislation.

You will find which states have enacted insurance reform laws and which states are pursuing autism insurance reform bills in 2011.

Moving Out of State to Get Autism Treatment by Paul Frysh (CNN, September 17, 2010)

http://www.cnn.com/2010/HEALTH/09/17/autism.aba.legislation/?hpt=3DSbin

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4 responses so far ↓

  • 1 Eliece 04/10/11 at 11:08 pm

    I live in Utah which is one of the states that hasn’t passed the autism initiative. What can I do to help get this passed in Utah? I don’t know where to start… Please HELP!

  • 2 Theresa IL 02/23/11 at 12:03 am

    Stephen, I believe the law allows the services to be billed first to the insurance if the parents agree.

  • 3 Stephen 02/19/11 at 9:39 am

    Massachusetts has passed autism insurance legislation. A school system is telling parents that they agree the students with autism need home ABA services due to the intensive needs of the students and noted regression over short breaks inbetween services, but that the parent’s insurance company has to provide the services. Is this legal?

  • 4 Theresa IL 02/15/11 at 12:06 pm

    Do you have any advice regarding how to work with private paid ABA treatment programs and school services for a child with autism? How can we help our child receive an overarching program for non-academic areas such as self-help, social skills, and following directions? It seems disjointed and confusing to us, it probably is to the child also. Any advice or case law? PS the school has their own “autism expert” and I don’t know if they are open to collaboration… (Child gets good academic grades for the most part). Thank you for any help.