Bill would require insurance coverage for autism spectrum disorders

Health insurance policies issued in Nebraska would be required to cover the screening, diagnosis and treatment of autism spectrum disorders (ASD) in individuals up to 21 years of age under a bill heard Feb. 7 by the Banking, Commerce and Insurance Committee.

As introduced, LB1129 would require coverage for behavioral health treatment, including applied behavioral analysis (ABA) and other evidence-based care up to a maximum benefit of $70,000 per year for individuals 9 years of age or younger and $20,000 per year for those 10 to 21 years of age.

Lincoln Sen. Colby Coash, sponsor of the bill, recommended that LB1129 be amended to require $70,000 of coverage for the first three years of treatment and $20,000 for each subsequent year until age 21. He said the change would allow children diagnosed with ASD to access intensive therapies for the first three years of treatment, regardless of the age of diagnosis, which he said is essential to an individual’s long-term outcome.

“This is not new,” Coash said. “We would not be the first state to say that this kind of coverage makes sense for its citizens.”

The bill defines ASD as any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including autistic disorder and Asperger’s disorder.

Michael Wasmer of Autism Speaks testified in support of the bill, saying 29 states have passed similar legislation.

Wasmer said premium rate increases have been minimal in the other states that have implemented autism insurance reform. He said an actuarial study using Nebraska demographics estimates a $1.21 per member, per month increase if LB1129 becomes law.

“[This bill] is cost effective and the right thing to do for Nebraskans,” he said.

Cynthia Ellis, a pediatrician at the Munroe-Meyer Institute in Omaha, also supported the bill. She said approximately one in 110 children is diagnosed with ASD. Well established behavioral treatments exist, she said, but rarely are covered by private insurance or Medicaid.

“Autism is fairly common,” Ellis said. “Autism is treatable.”

Cathy Clark-Martinez, whose son has autism, testified in support of the bill, saying her family filed for bankruptcy after paying $62,000 per year for behavioral therapy that insurance would not cover. She said her 8-year-old son missed a valuable year of therapy while the family weighed their options.

“Finances were the only reason we didn’t [initially] do ABA,” Clark-Martinez said.

Jan McKenzie of the Nebraska Insurance Federation testified in opposition, saying insurance providers do not define ABA therapy as a medically necessary treatment for autism spectrum disorders.

The committee took no immediate action on the bill.