Coverage for autism spectrum disorders proposed

Applied behavior analysis and other treatment for autism spectrum disorders would be covered by insurance under a bill heard Feb. 26 by the Banking, Commerce and Insurance Committee.

LB505, introduced by Lincoln Sen. Colby Coash, would require insurance plans in Nebraska to provide coverage for autism screening, diagnosis and treatment provided by a board-certified behavior analyst or licensed psychologist. Disease-specific and self-funded employee plans would be exempt from the bill’s provisions.

Required annual coverage amounts would be a maximum of $70,000 for the first three years of treatment and a maximum of $20,000 for the remaining years of treatment until a patient is 21 years old.

Benefits could not exceed those prescribed in plans purchased via the state’s federally facilitated exchange established under the Affordable Care Act.

In addition, a small employer with a group health plan would be eligible for a waiver from the bill’s requirements if the employer demonstrated to the state Department of Insurance that such requirements have resulted in a 2.5 percent increase in the policy’s costs over a calendar year.

Coash said the lack of coverage for applied behavior analysis (ABA) is a serious financial burden on parents seeking to provide the best treatment for their autistic children. Mandating ABA coverage likely would raise premiums minimally, he said, but would save taxpayers money in the long run.

Autistic children who receive early intervention are less likely to need specialized services in school and are more likely to lead independent lives as adults, Coash said.

“One out of 88 kids in our country are diagnosed with this disorder every year,” he said. “This bill is life-saving for people who have family members who need this treatment.”

Mike Wasmer of Autism Speaks supported the bill, saying 32 states have passed similar legislation. A study of claims data from those states indicates that mandated ABA coverage has had minimal financial impact on insurance policy holders, he said, adding that the same would be expected in Nebraska.

“The conclusion was that it was very unlikely that such costs would have an appreciable impact on premiums,” Wasmer said. “Failure to enact this bill is the high cost option.”

Cathy Martinez, whose son Jacob has autism, also supported the bill. The family spent nearly $250,000 for uninsured treatments for Jacob over a five-year period, she said, eventually filing for bankruptcy.

“Most children go without ABA in Nebraska because of the inability to pay,” Martinez said.

Dr. Debra Esser, vice president of medical affairs at Coventry Healthcare, testified in a neutral capacity. Representing Coventry Healthcare, United Healthcare and Blue Cross and Blue Shield of Nebraska, she said that all three companies have been involved in discussions on LB505 and are committed to continue working on the language of the bill.

“As insurers, we agree that early detection and treatment will give the highest benefit,” Esser said. “We’re not opposed to a mandate because it levels the playing field across insurers.”

No opposition testimony was given and the committee took no immediate action on the bill.