“Unexpected hurdles may face W.Va. autism measure - BusinessWeek” |
| Unexpected hurdles may face W.Va. autism measure - BusinessWeek Posted: CHARLESTON, W.Va. With the House of Delegates poised to vote Thursday on requiring insurance coverage for autism treatment, West Virginia officials are researching whether the long-sought proposal might run afoul of a 2002 law addressing mental health benefits. The federal health care overhaul might also come into play, depending on whether its eventual roster of essential benefits includes applied behavioral analysis, or ABA therapy. The pending state legislation would require insurers to pay for this treatment, considered crucial for children with an autism spectrum disorder. The diagnosis applies to an array of neurological illnesses marked by problems with communication, behavior and social skills. It is considered more common among children than diabetes, spina bifida, or Down syndrome. The House version of the proposal would require both public and private insurers to cover ABA therapy. But it would also cap benefits at $30,000 annually for children ages 3 through 6, and at $1,000 per month for ages 7 to 18. A group of delegates is seeking to amend that monthly cap to $2,000 before Thursday's vote on passage. The Senate also has a version of the proposal. It contains no caps but is limited to private group insurance and the Public Employees Insurance Agency. The 2002 law aims to put mental health coverage on par with other medical benefits. But it also allows insurers to limit benefits and take other steps when their spending on mental health exceeds 2 percent of a given plan's total costs. "It's fair to say we think there is a question as to how this would interface and interact with mental health parity," said Fred Earley, president of Highmark Blue Cross Blue Shield West Virginia. State Insurance Commissioner Jane Cline said Wednesday that her office is reviewing whether the pending legislation could trigger that law's cost-containment provision. Cline also said that she cannot recall any insurer invoking that provision since the law's enactment. The federal health care overhaul, meanwhile, would be a factor if it deems ABA therapy as essential but sets a less-generous benefit than what West Virginia may require. The difference would be whether the state would qualify for federal funds to subsidize consumer insurance premiums. "If the state adopts something that goes beyond that, that will become a cost for the state," Early said. "That's a very uncertain area right now. I don't believe there will be any guidance until at least later this year." The Council for Affordable Health Care, an industry research group, estimates that mandating this coverage increases premiums by between 1 and 3 percent. Overseeing the state's largest private insurer, Earley considers the House's version the more prudent approach. While 23 other states already require ABA therapy coverage, at least 17 also limit benefits. "Our concerns with the Senate version is that it really goes well beyond what other states have done," Earley said. "It would be more appropriate to be consistent with what other states have passed." Supporters favor the Senate version. Among other reasons, they cite the need for early diagnosis and treatment and question why the House would not require coverage before age 3. One in every 110 children in the U.S. has autism, the federal Centers for Disease Control and Prevention estimates. West Virginia education officials counted around 1,230 students with autism in the state's public schools last year. This entry passed through the Full-Text RSS service — if this is your content and you're reading it on someone else's site, please read our FAQ page at fivefilters.org/content-only/faq.php This posting includes an audio/video/photo media file: Download Now |
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