Insurance help for autism in Pa

July 3, 2008 1:59:00 PM PDT
Pennsylvania lawmakers pass landmark bill giving parents of autistic kids financial help; measure also gives Insurance Dept. power on merger of 2 health insurance giants.

Parents of autistic children would be able to pay for behavioral therapy and related services with private health insurance starting next year, under legislation that strikes a compromise between the insurance industry and advocates for the disabled.

The House of Representatives on Tuesday unanimously passed the measure, which also would give the state Insurance Department power to approve the proposed merger of Pennsylvania's two largest insurance companies. The Senate on Wednesday night approved the bill 49-1 to send it to Gov. Ed Rendell, who said he would sign it.

"It is a national model, a gold standard" for the coverage of autism-related treatments, Sen. Jane Orie, R-Allegheny, said in a speech on the Senate floor.

Autism is a complex developmental disorder that is often not diagnosed in children until after age 3, and can impair a person's ability to communicate and interact with others. Its severity varies from person to person.

"It's so critical for these families ... when you live with the tragedy of people rejecting their kids as if they don't have value, because we don't provide the services that are necessary to their developmental achievement," said House Speaker Dennis O'Brien, R-Philadelphia, a longtime advocate for the disabled whose 22-year-old nephew has autism.

The bill would require insurers to provide up to $36,000 in coverage initially for autism therapy for people under 21; the state's Medicaid program would pay for any costs that exceed that cap. Businesses with 51 or more employees would have to offer the coverage starting July 1, 2009, while smaller businesses would not have to provide any autism coverage.

Nearly two dozen other states have laws mandating some level of autism insurance coverage, according to the National Conference of State Legislatures.

Pennsylvania officials have estimated that more than 21,000 children between the ages of 2 and 20 have autism and related disorders. About 13,800 of them are insured under the state's Medicaid program.

But Medicaid coverage has shortcomings because a limited number of treatment providers accept it and the benefit is limited to the most severely disabled children, among other reasons, according to a recent Pennsylvania Health Care Cost Containment Council analysis of the legislation.

Insurance companies argued that a mandate would be too expensive. But they ultimately accepted a version of the bill that would require coverage for services that either improve children's behavior or help them maintain their developmental progress - something O'Brien said would preserve services for children receiving Medicaid insurance when their coverage switches to a private insurer.

"It is a reasonable balance of legitimate, competing concerns," said Sam Marshall, president of the Insurance Federation of Pennsylvania.

The legislation is expected to save the Medicaid program $13 million in the 2009-10 fiscal year. The health care council estimated that the proposal would cost the average policyholder about $1 a month in premiums.

Linda Amity of Monroeville, whose 10-year-old son and 7-year-old daughter both have autism, said she hoped the expected savings would enable the state to spend more Medicaid dollars on services for adults with autism, such as job training.

"That's a critical need, because after high school we are definitely going to need services for them ... so they can live as healthy and as independently as they are able," Amity said.

The bill also would authorize the Insurance Department to approve or reject the proposed merger of Independence Blue Cross and Highmark Inc. and allow the House and Senate insurance committees to make recommendations on whether the two companies should consolidate.

Currently, the department can only decide whether to allow a change in control of the Blues' for-profit subsidiaries. It cannot approve or reject the merger of their holding companies.

"The insurance commissioner should have the right to fully either veto or approve that merger," Rendell said.

The Blues announced their intention to merge in March 2007. The consolidation would create the state's largest health insurer, controlling more than 50 percent of the statewide market.

Additionally, the bill would require insurers to cover colorectal screenings.


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