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UPDATE: Autism insurance mandate passes General Assembly

Wednesday, May 12, 2010 | 3:48 p.m. CDT

JEFFERSON CITY — To pay for intensive therapy for their autistic children, Missouri families have maxed out credit cards, refinanced homes and depleted their savings. Soon, their costs could be covered by health insurance.

Missouri lawmakers gave final approval Wednesday to legislation requiring group insurance policies regulated by the state to cover up to $40,000 a year of behavioral therapy for autistic children through age 18.

Gov. Jay Nixon is expected to sign the mandate, adding Missouri to a growing list of states that have enacted autism insurance laws within the past several years.

"It's just a wonderful thing," said Molly Schad, her voice cracking with emotion, as she celebrated passage of the legislation with other parents of autistic children.

"It would give each child an opportunity to get to their potential, to make them as independent as they can be," added Schad, of St. Charles, who spent the past three years urging lawmakers to mandate autism insurance coverage.

The bill passed the House 144-16 and the Senate 27-6.

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. Children with autism often have problems with communication, behavior and social skills.

Missouri's law would require insurers to cover the diagnosis and treatment of autism beginning Jan. 1. Coverage generally would be capped at $40,000 a year for "applied behavioral analysis," an intensive therapy that some parents say produces dramatic improvements in their autistic children. That cap could rise every three years based on inflation.

The mandate would cover 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 — not a requirement — to buy autism coverage.

Businesses with 50 or fewer employees could get an exemption from the autism insurance mandate if they can show it caused their premiums to rise by at least 2.5 percent over the previous year.

An actuarial analysis last year by the consulting firm Oliver Wyman — conducted for 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.

Insurance companies have warned of larger increases. But some insurance lobbyists joined in the negotiations on the bill and remained neutral on the version that ultimately passed.

"This appears to be the best version — the least intrusive to us — but we're still not going to endorse mandates," said Shannon Cooper, a former Republican lawmaker who lobbies for America's Health Insurance Plans, which represents health insurers.

The bill's sponsors include at least two lawmakers with autistic relatives. Sen. Eric Schmitt, R-Glendale, brought his autistic son, Stephen, to the Capitol for Wednesday's vote. The 6-year-old autistic grandson of Rep. Dwight Scharnhorst, R-Manchester, died of epilepsy in 2007.

Nixon said he hopes the autism insurance legislation will not only help families pay their bills, but attract more autism research to Missouri.

"Getting this done, getting this stream of income for these families to have that coverage, is the first step to make Missouri the place people go and the place where the light comes on for thousands and thousands of more kids," Nixon said.

Seventeen states already have laws requiring insurers to provide coverage of medically necessary autism services such as behavioral therapies, with varying coverage limits, according to Autism Speaks. Those figures do not include Missouri or Vermont, where legislation pending before the governor would require coverage of autism therapies for children between 18 months and age 6.

Two additional states — Kansas and Iowa — enacted laws this year requiring coverage of autism therapies for state employee health plans, but not those in the private sector.


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