House endorses bill to require autism coverage

HELENA – The state House gave its initial approval today to a bill that would require insurance companies to cover a variety of childhood autism treatments. The vote was 77-23.

Senate Bill 234, carried by Rep. Kendall Van Dyk, D-Billings, would compel insurance providers to fund treatments that have been shown to improve the quality of life for autistic children.

“I stand here, as sure as I ever was, that we’re going to do the right thing by Montana families,” Van Dyk said.

The House Appropriations Committee originally placed a two-year sunset provision on the bill, meaning the mandated insurance coverage would end in 2011 if the next Legislature decides not to renew it. Rep. Walter McNutt, R-Sidney, said the sunset was not meant punitively, but as a safety valve in case insurance rates rise too high as a result of the mandated coverage.

“We don’t really know what this is going to do to insurance premiums,” McNutt said. “We just wanted to say we better take another look.”

But supporters of the bill said the sunset would prevent many families from getting benefits from their insurance companies because the bill would not take affect until 2010. In the end, the House voted 58-42 to strike the sunset provision.

Minority Leader Scott Sales, R-Bozeman, said though the bill has merit, the state cannot afford $1.4 million price it will cost to provide such coverage for state workers.

“At some point we’re going to break the bank,” Sales said. “That day is coming sooner than later.”

But supporters asserted the benefits of treating autistic children early on outweighed the future problems that could come with untreated children.

“We can’t afford not to do this,” said Rep. Jon Sonju, R-Kalispell.

-by CNS correspondent Molly Priddy

Senate approves coverage for autism treatments

HELENA – The state Senate approved a bill today that would require insurance companies to cover a range of treatments for children diagnosed with autism. The bill passed 36-14.

Senate Bill 234, sponsored by Sen. Kim Gillan, D-Billings, would compel insurance providers to fund treatments that have been shown to improve the quality of life for autistic children.

The bill, which faced a tough road in the current economic downturn, garnered emotional testimony during its hearings. Parents said they paid for these treatments out of pocket and could hardly afford to do so. Supporters told lawmakers that these treatments can help children assimilate into society at an early age and give them equal footing in the long run.

But opponents said forcing insurance companies to cover these treatments would prove costly because of rate increases. Insurers said a hike in insurance costs could make more Montanans drop their coverage and go uninsured.

SB 234 will move on to the House for approval.

-by CNS correspondent Molly Priddy

Lawmakers weigh fate of autism treatment bill

By JENNIFER KIRBY
Community News Service
UM School of Journalism

Parents of children with autism are awaiting a key decision this week on legislation that would require insurance companies to cover a range of treatments for autism that have been shown to improve a child’s quality of life.

Senate Bill 234, sponsored by Sen. Kim Gillan, D-Billings, awaits action by the Senate Finance and Claims Committee. Given the economy and falling state revenues, any bill with costs attached faces long odds, the bill’s sponsor said last week.

“It’s is going to be very tough to get it out of the committee,” Gillan said.

But in a hearing last week, Gillan stressed that working parents with insurance face high out-of -pocket costs to provide their autistic children with the treatment they need because insurance companies have been denying coverage of these recommended treatments.

Supporters of the bill delivered emotional testimony, emphasizing the cost of not treating a child with autism. They testified that the treatments addressed by this bill will save the state money in the long run, because children that receive early, intensive therapy are less likely to need special education services in school and state mental health services as adults.

But insurers warned that mandates for additional coverage mean higher costs that may cause more people to go without insurance. Frank Cote of Blue Cross and Blue Shield said that every time a mandate is passed, .25 percent of those insured drop their coverage because the increase in premiums is too much of a financial burden.

Estimates of what those costs would be ranged widely. Money to cover increased costs to state and university systems insurance plans could come either from additional appropriations or higher premiums passed on to state employees.

The budget office calculated that $1,375,466 in additional funding would be necessary to cover the cost of health coverage for state workers. State employees could see an increase $12.56 per month, if the costs are passed on to them.

But Gillan said those numbers are too high. Oliver Wyman Actuarial Consulting, Inc., an independent actuarial firm, calculated the cost of the increased benefits to be $12.70 per year, not per month.

Amendments to the bill have cut costs significantly by limiting coverage to children 18 years or younger and reducing the maximum benefit for older children because the treatments available focus on early intervention and are not as effective in children over eight years.

Coverage for services to maintain functioning of children with an autism spectrum disorder was eliminated, as was coverage for dietitian services.

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.