On July 1, Arizona will join several other states in prohibiting
medical insurance companies from excluding coverage for children with
autism spectrum disorder (ASD). While advocates are elated, the
implementation details remain somewhat sketchy.
The reasons for the new law are straightforward: Some insurance
policies now specifically exclude benefits for ASD-related treatments,
forcing parents of these children into a financial bind.
According to an article in the December 2008 issue of
Pediatrics, the journal of the American Academy of Pediatrics,
“Parents of more than half of (children with ASD) had to reduce or stop
work to care for their child.” More than 25 percent of these parents
spent 10 hours or more per week “providing or coordinating their
child’s care.”
In addition, the Pediatrics report found that families
including a child with ASD were more likely to have financial problems
than families including a child with other special health-care
needs.
To address this situation, the Arizona Legislature last year adopted
the new law requiring insurance companies to provide coverage for
“interactive therapies derived from evidence-based research.”
The statute defines ASD as including autistic disorder, Asperger
syndrome and pervasive developmental disorder. The Pediatrics study explains that children with ASD have “significant qualitative
limitations in social interactions, verbal and nonverbal
communications, and restricted repetitive and stereotyped patterns of
behavior, interests and activities.”
Kim Crooks, of the Tucson Alliance for Autism, says that federal
government figures from 2007 estimate between 3,500 and 5,000 children
with ASD in Pima County. She also reports that 73 percent of families
participating in her organization request some kind of financial
assistance.
Autism Speaks, a national advocacy organization, wrote in a press
release last year about Arizona households with ASD children: “These
families are either going broke trying to provide services for their
children or stitching together inadequate treatment plans because they
simply cannot afford the help their children need and deserve. That is
about to change.”
The new law requires insurance companies to provide a maximum of
$50,000 annually in benefits for ASD children up to the age of 9, and
$25,000 from 9 to 16.
“We’ll be sending a notice to our policyholders and also insurance
brokers,” says Renée Hunt, of Blue Cross Blue Shield of Arizona,
explaining how their customers will be notified of the law. However,
notification will be included with contract renewals—so some
policyholders might not get them until as late as next June.
How many people may use the new benefit, and how much that will
raise premiums, are two questions that remain unanswered.
Susan Pisano, vice president of communications for America’s Health
Insurance Plans, an organization based in Washington, D.C., did not
comment specifically on Arizona’s statute, but did offer some general
observations.
“The overall impact of mandates like this has been to increase the
cost of coverage,” she says. “That makes it impossible for many
employers to purchase (health insurance).”
A fiscal analysis prepared for the Arizona Legislature estimates
that policyholders on average will see premiums increase by half of 1
percent to pay for the new coverage. Thus, individuals and
families—presently paying thousands of dollars in annual
premiums—will probably see an increase of much less than $50 per
year.
On the other hand, the projected impact to the cash-strapped state
of Arizona—with 65,000 insurance-enrolled employees—is
about $3.6 million annually.
However, the implementation of the law could also save the state
money, thanks to a reduction in the caseload for the Division of
Developmental Disabilities.
Another uncertainty about the law is who will be allowed to diagnose
children with autism spectrum disorder. From her Washington, D.C.,
office, Rebecca Stelzner of Autism Speaks says, “We always favor
medical professionals. School principals shouldn’t do it.”
On the other hand, Peri Jude Radecic, director of the Arizona Center
for Disability Law, favors a much broader allowance for those doing
diagnoses.
“We would support (it being done by) individuals with experience in
diagnosis, not (necessarily) medical doctors,” she says.
While the question of diagnosis remains unsettled, the types of
treatment allowed by the law are clear. According to the statute,
“behavioral therapy” can be delivered to children with ASD in a number
of ways, including applied behavior analysis (ABA).
Stelzner thinks that’s a real positive. “There are 12 states with
similar laws,” she points out, “and it’s only ones including ABA that
we endorse.”
This article appears in Jun 18-24, 2009.