Legislative Update for May 20 – NC House Passes Autism Insurance Bill!

The following post was filed by Jennifer Mahan, Autism Society of North Carolina Director of Advocacy and Public Policy.

Crossover Week
Last week, the legislature finished a very busy week known as “crossover.” During each long session the NC General Assembly sets a deadline for policy bills to be approved by one chamber or the other (NC House or NC Senate) so that they can be considered by the other chamber. For example, if a House bill does not get passed by the House, it “dies” (does not go to the Senate) and under most circumstances cannot be brought up for consideration again until the next long session in 2015.

Some bills are not subject to crossover; mostly those that have to do with the budget and appropriating funds. Each chamber sets its rules for which bills need to meet crossover, so sometimes there is a rush to get bills through even if they have money attached to them or impact the budget.

Autism Insurance and Crossover Week
Crossover week is incredibly hectic. Legislators work long days with added committee meetings and long sessions into the night debating bills. This is the atmosphere in which H498, Autism Insurance Coverage, passed the NC House on Wednesday May 15th around 9PM.

The previous day, Tuesday, May 14, the House Insurance Committee had an afternoon hearing on the revised bill, and gave it a favorable report 25 to 4. With that favorable report HB 498 moved on to a hearing in the House Appropriations Committee around 7PM that same night (Tuesday). Eight amendments were proposed during the Appropriations debate and seven were adopted making many changes to the bill (see below for a summary of the new bill). The bill was then added, along with other bills that passed committees that day, to the revised House calendar (the “supplemental calendar”) for the next day, Wednesday, May 15th.

Wednesday’s floor session debate began late in the afternoon and carried over into the evening. Floor debate regarding HB 498 began at 7:50 PM. Our bill sponsors successfully defended the bill against several new amendments that would have significantly weakened the bill including one that would have removed 95% of the insurance plans in the state. The sponsors and other Representatives argued eloquently for the bill: both about its reasonableness for businesses in the state as well as the importance of providing this coverage to children and young adults and how much it will help them and their families. Once the amendments were voted on all of us following the bill held our breath as the Speaker called for the vote. The House allows 15 seconds for members to vote electronically. After 15 seconds that seemed like 15 minutes the vote results were announced: 105 in favor and 7 against (a few of the 120 members were absent). The final vote tally was an incredible show of support! Over the last few days and even hours preceding the vote several members changed their minds and voted in favor.

Thank you to everyone for your advocacy. As I visited with Representatives and checked in with the other advocates working on the bill, I heard over and over about the calls and emails they were receiving in support of the bill. Grassroots advocacy works!

While we are very pleased to have moved HB 498 out of the House, ASNC will need your continued involvement as the bill moves to the Senate where it will need to go through a similar process including committee hearings and a Senate floor vote. Please keep an eye on your email, this blog, and our Facebook and Twitter feeds for future calls to action.

The bill currently includes the following provisions (as amended by the NC House):

• Covers diagnosis and treatment of autism spectrum and related disorders, including ABA therapy.
• Covers children and young adults up to age 23, who are diagnosed by age 8.
• Caps yearly behavioral benefits at $36,000.
• Allows businesses with 50 and under employees to request a waiver from the requirement to offer this coverage if they can show their health care costs have increased by more than 1% over 12 months as a result of offering coverage for autism.
• Covers group plans in North Carolina who are subject to NC law as well as the State Health plan.

Links to the full content of the bill and an overview of its history can be found here.

For more information you can contact Jennifer via email at jmahan@autismsociety-nc.org or 919-865-5068.

Autism Insurance Update: Insurance Committee Hearing for H 498 Scheduled!

House Bill 498 that would require group insurance plans and the state health plan in North Carolina to cover treatment of autism is scheduled for a House Insurance Committee hearing on Tuesday May 14, 2013 at 1PM in room 1228/1327 of the Legislative Building. The House bill would ensure that plans for companies that operate in North Carolina and that are required to follow North Carolina insurance laws would cover diagnosis and treatment of autism, including applied behavioral therapy. Thirty-three states now have similar laws requiring autism insurance coverage. You can read Autism Society of North Carolina (ASNC) CEO Tracey Sheriff’s opinion piece about the law  as well as parent Beverly Moore’s op-ed. The Insurance Committee hearing is the first step in passing the bill in the NC House; if it receives a favorable report (majority vote yes to move it forward) it will likely go to an Appropriation Committee and then to the House floor for two votes. Once it passes the House, we move on to advocating for it to pass in the NC Senate.  It must pass both NC House and NC Senate chambers and be signed by the Governor to become law.

If you are signed up for ASNC’s monthly e-newsletter, and you live or work in one of the districts represented by a NC General Assembly House Insurance Committee member, you should already have gotten an alert from ASNC asking for your help. (If you have not updated your email address with us, please sign up so we can update your information.)

We are asking that constituents (meaning you live and or work in their legislative district) contact their own legislators who sit on the House Insurance Committee and ask for their support on H498. Please do not email or call every member of the Insurance Committee.

• Look up your NC House of Representatives Legislator using the district map (it is the one at the very top).
• Look up the list of Insurance Committee members to see if your Legislator is on the committee.
• If they are, please email or call and ask for their support on H498. Share a short version of your story about how autism has affected you, your family or those you care about.

If your NC General Assembly House Member does not sit on the Insurance Committee, you may still contact them to ask for their support. Look up your NC House of Representatives Legislator.

• Please look at the list of sponsors for H498 before you take any action.
• If your House member is a co-sponsor, you can thank them for their support on H 498 and ask that they continue that support throughout the process of getting the bill passed.
• If your House member is not a co-sponsor, ask that they support H 498 when it comes up for a vote.
• Share a short version of your story about how autism has affected you, your family or those you care about.

If you are considering  attending the House Insurance Committee hearing next Tuesday, you should know a few things before going to the Legislature:

• Your advocacy has helped us get to this point, regardless if you can attend that day or not.
  • Personal contact with your legislators in person, by phone, in letters and in emails is still the best way to be an effective advocate and we thank you for all your efforts on this issue and all the others that help those on the autism spectrum and their families.

• The day of the hearing is not a day to protest or to “storm the gates.”
  • Signs and posters are not allowed in the legislative building. While many of us are frustrated about the length of time it has taken to pass the bill in North Carolina, expressing that frustration will not help the cause. Respectful and courteous behavior, even in the face of disagreement over the issue, is the best way to represent our issues.

• The bill may or may not be heard the day it is put on the committee calendar.
  • Sometimes bills get put on the committee’s agenda, but get moved to another day. This is normal during busy legislative weeks and does not mean there is no support for the bill or that the bill will not pass.

• Room 1228/1327 where the House Insurance Committee meets is a small narrow room in the legislative building with about 80 seats in the audience.
  • It will be crowded with legislators, staff, reporters, lobbyists, and other people interested in this bill and in other bills on the agenda. Please be sure to make arrangements for childcare as this is not a good day to bring your child(ren).

• The audience at the committee meeting *will not* be invited to speak about the bill.
  • In fact, audiences at the legislature cannot clap, shout, or otherwise comment loudly on the proceedings. Your opportunity to speak to your legislators about the bill comes before or after the meeting. If you want to try and arrange a meeting, please contact Jennifer Mahan at the Autism Society of NC or contact your legislator directly. Please know you may not be able to get a confirmed meeting at the last minute and meetings frequently change.

• The Insurance Committee room has bad sound.
  • You may have difficulty hearing the questions or responses because the room is not set up well for sound. Legislators at the front of the room can hear each other and hear the presenters, but there may be times when you cannot hear.

• Legislators are not experts in autism.
  • You have done a lot to educate them about autism over the last few years (and decades) but they may ask questions or make comments that surprise you. The speakers may or may not fully address the issues in the short time to discuss the bill. This is an opportunity to continue to educate people after the meetings.

• Please look at the Legislative website citizen’s guide and other information about the downtown area in order to locate the building and public parking.
  • Parking sometimes fills up during the day because the Legislative building is located near several museums. Most public lots are two dollars an hour or more for parking and take credit and cash. Please be sure to park legally – Raleigh tickets and tows regularly.

Reminder: The NC General Assembly (NC House and NC Senate) is responsible for passing laws in North Carolina. Congress (which also has a House and a Senate) passes laws for the entire country, including North Carolina. Some insurance plans, such as those for those for multi-state or multi-national companies, those that are self-funded, and those for Federal employees, are the responsibility of the Federal Government and Congress. The NC General Assembly cannot pass legislation changing those insurance requirements. If you have questions about who represents you in the General Assembly or in Congress, or questions about this or any public policy issue, please contact Jennifer Mahan, Director of Advocacy and Public Policy at the Autism Society of North Carolina. Or you can post your questions in the comments section below.

Autism Health Insurance Reform

The following column was written by Autism Society of North Carolina CEO Tracey Sheriff.

State lawmakers have an opportunity to right an unfortunate injustice this legislative session. Currently in North Carolina, the nearly 60,000 individuals with autism and their families face unfair financial hardship because of an inequality in their health insurance coverage.

To correct this inequality for North Carolina families, House members from both sides of the aisle have introduced House Bill 498 which requires private health insurance companies and the North Carolina State Health Plan to cover the diagnosis and treatment of autism.

Thirty-two states currently require autism insurance coverage, while eight more are considering similar legislation. This legislation has afforded thousands of families in other states access to autism treatment that until now was only available in select corporations and through the federal government’s TRICARE insurance program. The 40 House sponsors of HB498 have taken an important step towards assuring this same access to autism treatment for North Carolina families.

Today one in 88 Americans are born with autism, a non-curable but treatable neurobiological disorder that impacts communication, social interaction and behavior. The National Center for Disease Control describes autism as one of the nation’s most critical health issues and its incidence is on the rise. Autism affects more children than cancer, AIDS and diabetes combined.

And it does not differ from other non-curable chronic medical conditions that health insurance routinely covers, including asthma, diabetes and hypertension. Yet children with autism do not have access to the health insurance coverage for treatment that is routinely provided for these and other health disorders.

The cost of autism care is $90 billion a year in the U.S. and places a heavy burden on the families who live with the disorder but cannot afford appropriate autism treatment. These families are paying health insurance premiums, yet their child with autism is excluded from coverage.

Families face the day-to-day challenges of raising a child with autism plus the additional financial hardships that result from health insurance exclusions. Unreimbursed out-of-pocket expenditures for medical care and autism treatment put families in financial insecurity, debt and even bankruptcy as they utilize savings and retirement funds to pay for needed therapies. Alternatively, families are forced to make the agonizing decision to not provide their child with these evidenced-based therapies known to improve symptoms dramatically.

While the costs of autism care are staggering, the cost for autism health insurance coverage is minimal. The insurance industry’s own claims data show that autism insurance coverage generates an increase in premiums of less than one percent.

In our state, that small investment would yield big returns. Autism treatment focuses on diminishing or controlling symptoms that can range from mild to quite severe. Research shows that symptoms of autism can be improved by appropriate evidence-based therapies thus improving the quality of life for the individual and his or her family and reducing the long-term costs to society of caring for untreated children. Every new child diagnosed with autism will cost an estimated $3.2 million over his or her lifetime. Early diagnosis and intervention can reduce this cost by two-thirds. Autism insurance coverage will help make this happen.

Autism insurance coverage would reduce costs to schools because children with autism would receive a head start on appropriate therapies before they entered the school system. Autism insurance coverage would also attract new health care jobs to North Carolina. Availability and access to board certified behavior analysts and other evidence-based autism treatment providers would grow if lawmakers require autism insurance coverage. And ultimately, autism insurance coverage would save taxpayer dollars by reducing the long-term costs of care.

The Autism Society of NC has been promoting opportunities and providing supports for North Carolinians with autism and their families for over 40 years. Every day, we hear from families about the hardships they experience from this unfair health care insurance exclusion. Along with many community partners and lawmakers, we have been working tirelessly to pass autism health insurance coverage in NC. This year, we encourage lawmakers to make it a reality.

HB 498 has already attracted 40 House sponsors from both sides of the aisle. We urge our remaining state lawmakers to join their colleagues and show their support for North Carolina families by correcting the exclusion of autism therapies from health insurance coverage.

Tracey Sheriff is CEO of the Autism Society of North Carolina. He can be reached at tsheriff@autismsociety-nc.org.

Autism Insurance Legislation Introduced in North Carolina!

 

North Carolina General Assembly Representatives Chuck McGrady, Tom Murry, Phil Sheppard and Trisha Cotham have introduced NC House Bill 498, titled “Mandate Autism Health Coverage.” The bill would ensure that health benefits plans in North Carolina will provide coverage for diagnostic and treatment services for Autism Spectrum Disorders in individuals in private and state health plans that are covered by North Carolina insurance law. HB 498 has been referred to the House Committee on Insurance, then if the bill receives a favorable report (they vote yes) the bill moves on to the next committee. The procedure is that bill must be heard in those committee and voted on favorably to be considered on the House floor.

We all know it’s the right thing to do, making sure that children with autism get the services they need to be healthy and successful. We also know that it will save money in the long run by promoting independence and less disability. North Carolina should join the other 32 states who now have coverage for autism spectrum disorder!

ACTION: The Autism Society of North Carolina is following this legislation closely and actively working to see it passed, but we need your help to make it happen. More and more Legislators are aware of autism, its impact and the need to address the issue even when they don’t completely understand autism spectrum disorder or the services and treatments. You can tell them that insurance coverage is something they can do to help and ask that they pass House Bill 498. Check the bill page and see if your General Assembly House member has put their name on as a sponsor or co-sponsor. Legislative districts changed last year so please be sure to check who represents you currently.

• If your NC House Representative has sponsored or co-sponsored, please call, email or write them a note thanking them for their support. This is a good time to let them know how much this means to you, your child, those you care about or those you serve 

• If your NC House Representative was not a sponsor it’s still important to educate them about this bill.  Tell them how much insurance coverage would mean to you and others who care about someone on the autism spectrum and that its time that North Carolina joined the other 32 states with insurance coverage laws.

If you have questions about this public policy issue or others affecting autism, please contact Jennifer Mahan, Director of Government Relations, Autism Society of North Carolina, 919-965-5068 or jmahan@autismsociety-nc.org.

Public Policy Update: Governor’s Budget, Education Scholarships, and Group Home Fix

 

 

 

The Autism Society of North Carolina advocates on public policy issues, monitors activities of the General Assembly and works to inform you about how these issue might affect people on the autism spectrum. If you have questions about these or other policy issues, please post your questions below or contact Jennifer Mahan, Director of Advocacy and Public Policy at 19-865-5068 or jmahan@autismsociety-nc.org. 

Governor Releases Budget Proposal

Governor Pat McCrory released his state budget proposal on March 20^th, in what will be the first step in a lengthy process to develop a state budget for the 2013-2015 biennium. Legislators had the opportunity to hear from the Governor’s budget staff March 21st about the proposal and to ask questions in a Joint Appropriations Committee meeting. The next step is for the NC Senate to develop their budget legislation, which does not need to be based on the governor’s proposal. More information on how the budget process works in North Carolina can be found at the end of the news article here.

The Governor’s budget overall maintains services and supports to individuals on the autism spectrum and those with other developmental disabilities; there are no major cuts to Medicaid and no major cuts to the Division of Mental Health, Developmental Disabilities and Substance Abuse Services.  Medicaid funding is increased to allow for growth in the number of people who will access the program due to changes with the Affordable care Act in 2014. A first reading of the 1300-page document reveals the biggest concerns for disability advocates to be:  1) a prior authorization requirement for obtaining mental health medications under Medicaid; in other states this has kept people with mental health conditions from getting needed medications and 2) the elimination of 3200 teacher assistants in 2^nd and 3^rd grades, and the lowering of the ratio of TAs to students in K-1, to pay for 1800 more teachers to address school enrollment growth.  Since many children with disabilities are now in mainstream classrooms, fewer teacher assistants in those grades could mean less assistance for kids with Individual Education Plans (IEPs) or 504 plans since teaching assistants often provide that additional support. Local school districts would have the flexibility to determine how those funds would be used, so it is not entirely clear what the impact of shifting those funds from TAs to teachers would be.

Education Scholarship for Students with Special Needs Would Replace Tax Credit

Representative Paul Stam, the original sponsor of the education tax credit for children with special needs, has introduced new legislation to change the tax credit into a scholarship program, House Bill 269.

This program is nearly identical to the tax credit program, assisting families who move their child with a significant disability out of the public school system and into a private or home school, with a few differences: 1) it would open the program to a wider array of income levels since it is not dependent on a family’s tax liability 2) it would grandfather into eligibility those currently eligible for the tax credit 3) it would include the provision that was intended to go into effect for the tax credit next year, requiring only one semester of public school in North Carolina to be eligible (the current criteria is two semesters) 4) it would be a set amount of money, $3000 per semester, unlike the variability of a tax credit.

The Autism Society of North Carolina worked to pass the tax credit bill and believes this bill is a positive change that will carry similar benefits to families and children as the previous law.

Since it uses scholarships, the new program would have a limited amount of funding, $3 million to start, so individuals would need to apply yearly for the funding (those currently getting a scholarship appear to have some priority in accessing the scholarships). However, given the above changes, we believe that the program will attract more families than the current tax credit since it is easier to use and available to all income levels. Rep. Stam intends for this program to be permanent, but of course the legislature cannot obligate future legislatures so there are no absolute guarantees.   Just like the tax credit, these scholarships would not be available to people who took their child with special needs out of public school prior to June of 2011 when the original tax credit bill passed. This will disappoint some parents who were hoping that legislation would eventually expand to include them – they have a good argument for more funding to support additional families and ASNC would continue to work with them to advocate for their position.  This is a good time to find an alternative to the tax credit as we expect major tax reforms are coming, either this year or next, and this tax credit could be lost.

ACTION: Please contact your North Carolina legislator and express your support for the scholarship program for children with special needs. If you believe the scholarship program would not cover your child due to limits in the eligibility criteria, state your belief that the program should be expanded to include your child.  NC House and NC Senate legislative voting districts changed this year, so you should check to see which district you are in and who currently represents you in the General Assembly on the new easy to use district map page.

Temporary Fix for Group Funding Problems Enacted

On March 6^th Governor Pat McCrory signed House Bill 5, Temporary Funding /Group Homes and Special Care Centers. This temporary fix to the Personal Care Services and group home crisis will allow group homes whose residents have been denied Personal Care Services to access special funding through June 30^th, 2013. This funding will keep the group homes operating and their residents cared for in the short-term. Governor McCrory, Speaker Thom Tillis, President Pro Tem Phil Berger, Senators Ralph Hise and Louis Pate, as well as Representatives Marilyn Avila, Justin Burr, Nelson Dollar, and all deserve thanks, along with the other bill sponsors and General Assembly members for their role in getting this bill passed quickly.

Since this is a temporary fix, the legislature must get a long-term fix in place before the temporary funding expires at the end of June. For the past several years, the intellectual and developmental disabilities (IDD) advocacy community, including the Autism Society of North Carolina, has been working on a proposal that serves as a long-term fix by allowing Medicaid funds to be used for support services in community settings using the “1915i option.” This “i” option offers an excellent opportunity to create a stable future for these individuals with IDD living in group homes, and thousands of others in other community settings.