McDonnell Amends Autism Bill to Mixed Reaction

By Fletcher Babb, Capital News Service

Gov. Bob McDonnell has proposed a series of amendments to legislation that would require large employers to provide insurance coverage for autistic children.

Among other cost controls, the governor would require parents to get prior authorization from their insurer before an autistic child can receive services.
“We have communicated with the patrons to ensure this legislation is in the proper form to guarantee the balance between meeting the needs of children with autism spectrum disorders, their parents who purchase insurance coverage, businesses who provide insurance to their employees, and the industry that provides the coverage,” McDonnell said this week.

The General Assembly will consider McDonnell’s changes Wednesday. Legislators will hold a one-day “reconvened session” to vote on the governor’s vetoes and legislative and budget amendments.

For more than a decade, parents of autistic children in Virginia have pushed for a state law requiring insurers to cover autism services. In February, the General Assembly passed two identical measures – House Bill 2467 and Senate Bill 1062.

The legislation would require health insurers to pay for a set of therapies, known as applied behavior analysis, for children aged 2 to 6 years old with autism spectrum disorders.

The new law would apply to businesses with more than 50 employees; it also would cover public employees. The statute would not apply to individual or small group insurance policies.

The bills would cap annual benefits for autism services at $35,000.
Doug Gray, executive director of the Virginia Association of Health Plans, said his organization disagreed with the kind of services covered by the legislation.
“The services are not health care services. They are educational services – the same that are provided in public schools,” he said.

Like Gray, many in the business community have opposed the new law, saying it puts a burden on employers in an uncertain economic climate.

“This bill uses insurance companies to finance these therapies,” Gray said.
John Toscano, president of the Commonwealth Autism Service, said Gray’s position is “misleading.”

He said that there is no known medical treatment for autism and that the most effective therapy is “the use of early and intensive intervention.”

Toscano acknowledged that some schools already provide treatments based on applied behavior analysis. But he said that “by the time children with autism reach school [age], they may have missed the opportunity for treatment.”

According to the National Conference of State Legislatures, 35 states and the District of Columbia have laws concerning autism and insurance coverage. Virginia would join the 23 states that specifically require insurers to provide coverage for autism treatment.

McDonnell issued a statement saying his amendments would make Virginia’s requirement less costly. His amendments include:

• Creating a licensure requirement for autism therapists through the Virginia Board of Medicine to ensure that families seeking treatment receive standardized care
• Requiring prior authorization of services from insurance companies “to promote access and quality control of services”
• Allowing an independent evaluation of the child’s treatment plan “to ensure that the treatment is justified and effective”
• Allowing a legal path to invalidate the law if a court or a federal law invalidates the $35,000 cap on benefits

“I recognize and thank those business owners who often make great sacrifices to provide affordable health care coverage to their employees,” McDonnell said. “I urge my friends in the General Assembly to approve these common-sense amendments.”

To read or comment on the legislation mandating insurance coverage of autism services, click here or here.