Changes in Coverage: Autism legislation passes Missouri House

Insurance companies would be mandated to provide coverage for Autism Spectrum Disorder (ASD) if legislation continues to move forward, after recent approval from the Missouri House of Representatives.

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According to Rep. Terry Swinger (D-Caruthersville), ASD diagnosed individuals not being covered by insurance plans has been an issue for several years.

"Last summer House Speaker, Ron Richards created an interim committee to create a plan for legislation of an affordable plan to mandate insurance coverage on autism to be pre-filed on Dec. 1, the first day legislation could be filed," Swinger said. "Legislation was pre-filed as promised and we finally debated House Bill 1311 and 1341 and passed on Feb. 18. It is now headed to the Senate."

Swinger said the Senate also has their version of ASD legislation, Senate Bill 618.

Information provided by Swinger defines Autism as a Neurobiological disorder which impairs social development and communication. Autistic children are unable to relate to others emotionally. Many times they display repetitive behavior. Autism can be mild or severe. It is usually diagnosed between birth and 3 years old. Many times a child appears to develop normally and then regresses almost overnight. For many years, 1 in 10,000 children were diagnosed with autism. Now it is 1 in 100 children. The cause of autism is unknown but, there are several unproven theories.

According to Swinger, parents have found that early treatment can make a difference in achieving some normal functioning.

"However treatments are not short term and are expensive, costing over $72,000 each year," Swinger said. "Currently Missouri has no insurance coverage for these treatments and this is where House Bill 1311 and 1341 and Senate Bill 618 would make a difference."

The two bills, as currently written, require all group health insurance plans to provide coverage for the diagnosis and treatment of ASD on or after Jan. 1, 2011. Services cannot be subject to any greater deductible, co-insurance, co-payment or utilization review than other physical health care services provided by the health insurance plan. It must provide coverage for Applied Behavior Analysis (ABA) which uses techniques to reinforce desired behavior, actions and skills with a maximum benefit of $36,000 each year up to age 19.

The Senate version differs giving a maximum benefit of $55,000 each year up to age 21.

"This is a step in the right direction to provide coverage for these children," Swinger said. "These children and their families deserve a chance to improve their lives. Hopefully this is the year we can pass this legislation."

For those who are unfamiliar with Autism, local resident Maime Benson, who has a 21-year-old Autistic granddaughter, said ASD positive individuals develop slower than those who do not have ASD.

"It is like a piece of the puzzle is missing," Benson said. "They learn differently."

Benson said she and many others have spent a lot of time fighting for the ASD insurance bill.

"We have fought for this bill," Benson said. "We have testified for it. It has been almost impossible to get insurance for Autistic children."

Benson said the insurance companies claim the cost is too expensive, however, she said it is only a few dollars more than plans without ASD coverage.

Benson said if coverage was available, parents could take the children to the doctor as they begin to develop signs of Autism, making it a little easier to begin the specialized learning process.

"If they had insurance to help with their needs, they wouldn't miss out on services they need," Benson said.

Benson said she was happy to hear that the bill passed the House and hopes it will pass the Senate.

"Hopefully this can bring more services to our area," Benson said. "[The bills are] a life saver for families with children with Autism."

Benson said anyone wanting more information on Autism can contact her at (573) 919-4143, or maimelbenson@yahoo.com.