Senate passes bill to provide coverage for autism

By JENNIFER KIRBY
Community News Service
UM School of Journalism

Montana's Senate endorsed legislation Monday that would require insurers to provide coverage for critical early intervention therapies for autistic children

Senators voted 35-14 for Senate Bill 234, also known as “Brandon’s Bill,” which would require coverage for the treatments recommended for improving an autistic child’s quality of life, including applied behavioral analysis – an intensive intervention that can require eight hours of therapy a day.

According to The Center for Disease Control, one in 150 American 8-year-olds has been diagnosed with an autism spectrum disorder. Before studies done in 2004, it was generally believed that about 1 in 2,000 children had autism.

The Obama administration has given special attention to autism in its disabilities agenda , calling for universal screening and increased funding for care and research.

In Montana, the bill's sponsor, Sen. Kim Gillan, D-Billings (pictured), said treatment, specifically applied behavior analysis, is routinely denied coverage by insurance companies, placing huge financial burdens on hard working families in Montana.

In Monday's debate, the bill drew bipartisan support. Sen. Bob Hawks, D-Bozeman and the grandfather of two autistic grandsons, said the potential cost of the mandate was small compared to the cost of no treatment. He implored lawmakers to give these families some assistance, now.

Sen. Roy Brown, R-Billings, said that he hated mandates, but this one deserved their support.

“Brandon’s Bill,” named after Brandon Simonsen, a Montana boy who was diagnosed with autism at age 3, drew supporters from across the state in an emotional hearing earlier this session. Parents relayed story after story of not being able to get coverage for the treatments recommended by their care providers.

In some cases, limits on coverage for speech and physical therapy left parents paying out-of-pocket for most of the treatment. Some plans denied coverage of applied behavior analysis, dismissing it as experimental or unproven.

The intensive nature and high cost of that treatment put it out of reach for most parents if their insurance did not cover it. For some parents, qualifying for Medicaid was the only way to secure treatment.

Insurance lobbyists argued that the bill was unnecessary because they are already required to cover autism as a severe mental illness. An additional mandate for coverage, with an annual maximum benefit of $50,000 required by “Brandon’s Bill,” could increase premiums for everyone, they argued. Small business and labor representatives echoed that concern.

To address concerns of cost and medical necessity of treatment, the bill was amended. Of particular concern was the estimated cost of providing coverage for government workers.

Gillan disputed an analyist's estimated $12 per month increase in premiums, citing an actuarial study that estimated an increase of only $18.50 annually, plus a 15 percent administration fee.

She said in Minnesota, where Blue Cross Blue Shield has been providing coverage for applied behavior analysis and other recommended treatments without a coverage cap, premiums increased by 83 cents per month. In Indiana there has been no measurable increase in premiums after a similar bill was enacted, she added.

Amendments to the bill maintain the $50,000 coverage limit for children 8 years old and younger, while reducing that benefit to $20,000 for children 9 to 18 years old.

Researchers believe early intervention is essential to helping autistic children develop to their full potential, especially if children are treated before they enter school. Treatment plans for children over age 8 are generally less costly.

Other changes in the bill address treatment plan specifications and certification for treatment providers. Coverage for nutritional therapy and dieticians services was eliminated. The effectiveness of the dietary intervention was challenged by a doctor representing an insurance group during the committee hearing.

“The changes made don’t detract from the bill but helped tightened some of the language, making it a better bill,” Gillan said later.

The bill faces one more vote in the Senate before it makes its way to the House for consideration.