Presentation Transcript

1. State Action on Autism Insurance Coverage

   Julie Erickson Registered Lobbyist American communications group, inc. November 14, 2013
2. Lawmaking Process in Nebraska An Idea, is researched by the senator and his/her staff. The bill may be to create a new law or repeal or alter an existing law. Introductionof the bill takes place in the first 10 days of the new legislative session. An individual senator, several senators or a standing committee can introduce the bill. Appropriations bills and bills introduced at the request of the Governor can be introduced at anytime during the session. A Standing Committee can introduce 8 bills; a Senator, an unlimited number. The Reference Committee assigns the bill to a Standing Committee, a Select Committee or a Special Committee. The bill is then scheduled for public hearing by the referred legislative committee. ALL bills introduced will receive a public hearing. Bills approvedby the Governor become law three calendar months after the legislature adjourns. Bills which have been approved with an emergency clause will take effect immediately.
3. Legislative Bill 505Introduced in 2013 by State Senator Colby Coash, District 27 (Lincoln) Bill Co-Sponsors: Senator Brad Ashford Senator Bill Avery (committed) Senator Kate Bolz Senator Danielle Conrad Senator Ken Haar (committed) Senator Sara Howard (committed) Senator Charlie Janssen Senator Russ Karpisek Senator Amanda McGill Senator Jim Smith Senator Norm Wallman (committed) Additional Co-Sponsor Targets: Senator Kathy Campbell Senator Mark Christensen Senator Tanya Cook Senator Sue Crawford Senator Steve Lathrop Senator Kate Sullivan LB 505 had a hearing on February 26, 2013 and is being held in the Banking, Commerce and Insurance Committee. The next step is for the committee to advance LB 505 to General File, first round debate on the floor of the legislature. The 2014 Legislative Session begins on January 8, 2014and is scheduled to adjourn after 60 working days on April 17, 2013.
4. LB 505: The Facts Requires all “non-qualified” health insurance plans sold in Nebraska, except disease specific and self-funded employee plans, to provide coverage for the diagnosis and treatment of autism spectrum disorders in children and youth less than age 21. Covered services include behavioral health treatment including applied behavior analysis (ABA) when provided or supervised by a board certified behavior analyst or licensed psychologist. Caps coverage for ABA treatment at $40,000 each year annually to age 21. To the extent that coverage exceeds the essential health benefits required under the Affordable Care Act, benefits would not apply to “qualified health plans”. Small employers with group plans may receive a waiver from the Nebraska Department of Insurance if the required coverage results in a 2.5% increase or more in policy cost in one year. Coverage is not subject to dollar limits, deductibles, copayments, or coinsurance provisions less favorable than equivalent provisions in physical health coverage in the policy. Today 1 in every 88 children are estimated to have an autism spectrum disorder; there has been a 1000 fold increase in the last 40 years. Without appropriate treatment the lifetime cost to the State has been estimated to be $3.2 million per child; the cost of providing health insurance coverage for the diagnosis and treatment of autism could be recovered through reductions in special education and medical expenditures alone. If paid for out of pocket, the cost of autism therapy can be financially devastating to families; most affected children go without or receive only a fraction of prescribed treatment. Actual claims data from States that were among the first to enact autism insurance reform laws demonstrate the average cost to be 31 cents per member per month. Fiscal projections in these States often greatly exceeded actual cost when consideration was not given to the fact that a) autism presents a spectrum of severity, therefore not all affected individuals are prescribed treatment of the same intensity and b) utilization of benefits is far less than 100%. A February 1, 2013 report by the Missouri Department of Insurance found that required coverage for the diagnosis and treatment of autism represented less than 0.2% of overall claims costs. The report states “it is very unlikely that such costs will have an appreciable impact on insurance premiums”. As of November 2013, 34 states have enacted legislation that requires meaningful coverage for the treatment of autism.
5. What Can You Do? Contact your state senator and urge their support of this legislation. Invite them to meet for coffee; meet at their office; invite them to your home; send them an email Share your personal story and struggles with them Introduce them to your child Urge your family and friends to email their senator and ask for support. Write a letter to your local newspaper, urging support for LB 505. If you don’t know who your state senator is, or need help finding their contact information, you can visit the legislative website, http://www.nebraskalegislature.gov/senators/senator_list.php, or contact Aubri Faustman at afaustman@acgusa.net.
6. The Affordable Care Act (ACA) The ACA requires States to defray the cost of benefits that exceed the essential health benefits specified in the law when individuals enroll in a “qualified health plan” offered inside an Exchange. Language in LB 505 clarifies that the proposed benefits will only apply to plans offered outside the Nebraska Exchange if HHS determines that the benefits exceed the essential health benefits; thus eliminating any obligation to the State of Nebraska to defray the cost of providing such benefits.
7. Nebraska Health Insurance Companies Continuing/New Health Insurance in NE (2014) Blue Cross Blue Shield of Nebraska Coventry Health CoOportunity Health Health Alliance Midwest John Alden Health Standard Security Time Insurance UnitedHealthCare Discontinued Health Insurance in NE (2014) American Family Mutual Insurance Companion Life Insurance Humana Insurance Independence American Insurance Reserve National Insurance Standard Security Life Insurance of New York United Security Life and Health Insurance Medicaid

8. The prevalence of Autism as reported by the Centers for Disease Control and Prevention (CDC) is now 1:88.

   This represents a 1000 fold increase in the past forty years. Autism is an epidemic and a publichealth crisis. The time to act is now.