Autism Insurance Update

explanationofbenefitsJuly 15, 2014

Background: Autism insurance reform legislation was passed by the NC House last year (H498) but the bill has yet to be taken up by the NC Senate. The bill would ensure that health insurance sold in North Carolina that is regulated by the NC Department of Insurance covers the diagnosis and treatment of Autism Spectrum Disorder. The bill would cover children and young adults from birth through age 23, if they were diagnosed by the age of 8. It would cover screening, diagnosis, and a variety of medically ordered therapeutic and behavioral interventions shown to ameliorate the symptoms of autism, including applied behavioral analysis (ABA). Coverage of behavioral interventions would be capped at $36,000 per year.

Currently the NC Senate has two autism bills pending in committee, H 498, passed by the House last year, and Senate Bill 493 (S 493), a regulatory reform bill that includes language about autism insurance. In the last two weeks neither bill has moved as the House and Senate have been focused on negotiations over the state budget. If you have not contacted your NC General Assembly senator recently about autism insurance, now is the time. The session has gone longer than usual, due to disagreements over the state budget, but a compromise will be reached on the budget in the next week or two and the session will end. We need to make sure the Senate takes up the autism bill soon! Details on contacting your NC Senator are below.

What’s next for autism insurance reform and the regulatory reform bill?

In review, S493, is Health and Safety Regulatory Reform. The House passed a new version of a Senate bill which now includes autism insurance reform with very similar bill language to House bill 498 (which was passed last year), as well as other health and safety issues. A new section in S 493 requires behavioral analysts to be licensed in North Carolina by a new licensing board, which is similar to other health-care professions. Because the state employees’ health plan has voluntarily adopted autism insurance (effective January 1, 2015), the section of the original language that covered state employees has been removed in the new bill. Because the House stripped a Senate bill that the Senate has already passed, and inserted the new health and safety regulatory bill language, the Senate has several options for how to proceed with the new bill language. They can:

  1. Concur with the House’s version, in which case the bill has passed and can move on to the governor’s desk
  2. Or, they can vote to not concur with the new bill language, and the bill would move to a conference committee. The House and Senate would each need to appoint committee members to work out differences between the two bills before the session ends.

Right now, both S493 and H498 remain in committee awaiting action by the Senate. At this time, we do not know what action the Senate will take on the new legislation.

How you can help:
Call or write your General Assembly Senator now! The insurance industry continues to oppose autism insurance reform legislation that would ensure better coverage of autism treatment in private insurance and we are concerned that Senators are listening to them, rather than to families and the facts.

You can find out who your state senator is here by entering your address in the second map. We urge you to be respectful in your comments and ask for their support in getting autism insurance coverage passed. (Please note, we appreciate the support of our friends and family in other states, but right now legislators need to hear from people in their own districts.)

Some ideas about what to say in your message:

  • Tell them a short version of your story of how autism is affecting you, your family, or a person you care for and what insurance coverage would mean for you.
  • Ask them to support autism insurance reform legislation in the Senate.
  • Treatments for the symptoms of Autism Spectrum Disorder are effective and result in better quality of life as well as lower future costs.
  • Autism treatments are medically ordered, proven therapies delivered by professionals. They are not “educational” or “experimental.”
  • The cost of autism health benefit coverage is very low; in states that have enacted it, the average cost is .31 cents per member per month.
  • The bill contains a small-business opt-out, if coverage related to autism causes premium increases of 1% or more.
  • The bill has no Affordable Care Act impact: There is a carve-out of all ACA plans, which means the ACA is a non-issue, and guidance from the federal government is not necessary.

If you would like to visit your NC General Assembly Senator to talk with them in person, please call their office directly, say you are a constituent, and ask for an appointment. Please contact the Autism Society of North Carolina at the number or email below for help in navigating the General Assembly, in locating the right offices, or with talking points and prep for your visit.

If you have questions about public policy issues, please contact Jennifer Mahan, Director of Advocacy and Public Policy, at 919-865-5068 or jmahan@autismsociety-nc.org.

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