Missouri lawmakers to try again on expanding autism coverage

Thursday, December 3, 2009 | 12:01 a.m. CST

JEFFERSON CITY — Missouri's top House official pledged his support Wednesday 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 less than 21 years of age. 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.

Insurance 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 an increase of less than 1 percent in the cost of premiums.

Nationally, about one 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 to 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.

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Ray Shapiro December 3, 2009 | 2:42 a.m.

("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.")

Is ABA the Best Choice for Your Child?

In general, practitioners suggest that intensive ABA is most appropriate for children with more profound autism, and/or for children who thrive in a structured atmosphere. Unfortunately, there is no good research comparing interventions head to head, which means that parents must make a choice based on (1) practical considerations such as finances and availability of therapy; (2) what works best for the family as a whole; (3) intuition (do you like the idea of a very structured, very intense program for your child? Do you think your child will do well in this program? Of course, one easy way to find out whether ABA will work for your child and your family is to give it a try. If it works -- terrific! If not, plenty of other options are available.
source and more:
Pros and Cons of ABA as an Autism Treatment

Office of Autism Services Navigating Autism Services: A Community Guide for Missouri Division of Developmental Disabilities Department of Mental Health:
The workgroup noted that several autism resource directories were now available in Missouri but expressed the need for a Navigation Guide to help people understand the services available for people with autism in Missouri, how to access these services, and where to start. Families often say that they are not given enough direction after a family member is diagnosed with autism. Many families find services later in their journey that they wish they had known about right away. The purpose of this Navigation Guide is to help ease the journey by providing basic information about autism, resources, and services for people of all ages with autism in Missouri. We hope this Guide will give you a place to start your journey.,
-Seems to me like a network and options already exist here in Missouri.
Why should government force private insurance companies to include ABA?
Perhaps we should be advocating for across State line insurance purchases so that access to out of state insurance company policies covering ABA and other expensive alternatives are also an option to parents of autistic children.
(Let those who want to pay the premiums buy into those out of state plans.)

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