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House passes autism insurance bill

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House passes autism insurance bill

Picture of Alison Knezevich
The Charleston (W.Va.) Gazette
Thursday, February 10, 2011

CHARLESTON, W.Va. -- West Virginia children with autism would have a much easier time getting treatment under legislation passed Thursday by the House of Delegates

The bill (HB2693) would make private insurance companies, the state's Public Employees Insurance Agency, and the Children's Health Insurance Program pay for a critical treatment for autism called applied behavioral analysis (ABA) therapy.

House members passed the proposal 96-1, sending it to the Senate.

Autism spectrum disorders are a group of developmental disabilities that affect a person's ability to communicate and interact with others. They range in severity and include pervasive developmental disorder, Asperger's syndrome and autistic disorder.   

ABA therapy can help children learn to communicate, develop relationships and gain other skills.

But it also can take up to 40 hours a week and costs an average of about $40,000 a year. For some people, it costs more than $70,000.

A similar bill (SB218) is pending in the Senate. Unlike the House version, the Senate proposal doesn't cap coverage.

The House bill limits insurance coverage at $30,000 a year for the first three years of treatment. After that, insurance would pay for up to $2,000 a month until the child turns 18.

Lorri Unumb, senior policy advisor for the national organization Autism Speaks, said her group prefers legislation with no caps, but "we are obviously thrilled that the House has moved forward with the bill."

Twenty-three other states make insurers cover ABA therapy, according to Autism Speaks.

Unumb also praised changes to the House bill that will require coverage beginning at the time of diagnosis, rather than at age 3 as originally proposed. Some kids are diagnosed as young as 18 months and early intervention is critical, she said.

"The brain is so malleable at a young age," she said. "I've heard a neurologist testify that they believe brains are literally being rewired though these therapeutic interventions."

Supporters of the bill say the it would save the state money in the long run by helping children with autism become productive citizens.

For some lawmakers, the issue is also personal.

"I've been giving speeches on this bill for four years," said Delegate Mark Hunt, a Kanawha County Democrat whose 10-year-old son has autism.

Delegate Ralph Rodighiero's son is 18 and was diagnosed with autism at age 5. 

After the diagnosis, Rodighiero's wife quit her job as a nurse. She received training at Marshall University and then spent all her time working with their son.

"It was a financial burden, but it was what had to be done to get my child where he is today," said Rodighiero, a Logan County Democrat whose son now attends community college and works in a local movie theater.

Freshman Delegate Denise Campbell, D-Randolph, has an 8-year-old son with autism. Living in Elkins, the closest provider of ABA therapy is a 90-minute drive away, she said.

The federal Centers for Disease Control estimates that 1 in 110 American children have autism. It is four times more common in boys than in girls.

Fred Earley, president of Highmark Blue Cross Blue Shield West Virginia -- the state's largest private insurer -- said he has concerns whenever a new requirement would add to the cost of insurance.

He also believes the House version will require too broad of coverage.

On Thursday, delegates amended the bill require insurance to pay for ABA tutors who are supervised by board-certified therapists.   

The original House proposal would have only covered treatment provided by board-certified therapists.

America's Health Insurance Plans, which represents insurance companies nationwide, generally opposes laws that require coverage of certain treatments, said spokeswoman Susan Pisano, citing the costs.

"There's a cumulative impact from the hundreds, actually thousands, of mandates," passed throughout the country, she said.

Delegate Ron Walters, R-Kanawha, voted against the bill Thursday. He is concerned that it is too broad and could create "double-billing opportunities" for insurance companies, he said.

"It has a number of flaws in it," said Walters, who is an insurance agent. "I'm hoping the Senate will [fix them] and I'll be comfortable with it when it comes back."

Reach Alison Knezevich at alis...@wvgazette.com or 304-348-1240.