It's time for Medical Insurance Companies in Oregon to cover Autism Treatment

Autism Health Insurance Reform: SB365 approved UNANIMOUSLY by Senate Health Care; On to Ways and Means

Contents:

  • Update – SB365 Approved by Senate Health Care committee
  • ACTION:  Please come to the Joint Ways and Means committee hearings around Oregon from 4/12 to 4/25 to support SB365 and HB2897!

Update – SB365 Approved Unanimously by Senate Health Care committee:

A few minutes ago, the Senate Health Care committee voted UNANIMOUSLY to recommend approval of SB365, the Autism Health Insurance Reform bill, with a new “-5” amendment negotiated at the last minute by representatives from the autism community and insurance industry.

Although we’re not getting everything that we wanted, we support this bill – it represents a very major step forward, and will help hundreds or thousands of individuals with autism to get the health care that they need.

As amended, the bill:

  • Establishes a streamlined approach for approval of ABA therapy for individuals with autism under the age of 9, seeking up to 25 hours of ABA therapy per week.  Once approved for ABA under this streamlined approach, ABA continues for as long as medically necessary and progress in treatment continues
  • Maintains existing legal requirements for coverage ABA therapy (and all other medically necessary care) for patients over the age of 9 or seeking more than 25 hours of ABA therapy per week under existing Oregon law (ORS 743A.168, Mental Health Parity, and ORS 743A.190, Children with Pervasive Developmental Disorders)
  • Requires insurers to continue honoring IRO decisions ordering coverage of ABA therapy.  Once the new statute takes effect, insurers may require treatment plans for such patients, but must continue to provide coverage for ABA as long as medically necessary and progress in treatment continues, regardless of age.  (This is what Kaiser is already doing)
  • Applies to all insurance plans that the state can regulate – including commercial insurance plans, PEBB, OEBB, the health insurance exchange, the Oregon Health Plan, and Healthy Kids
  • Creates the “Behavior Analysis Regulatory Board” to license providers of Applied Behavior Analysis (ABA); allows existing qualified, licensed providers (such as psychologists, speech therapists, and occupational therapists) to obtain reimbursement for ABA therapy, and temporarily grandfathers any provider already providing ABA therapy.  Protects the interests of professions involved with delivery of ABA services by including a psychologist, a speech language pathologist, and a developmental pediatrician or psychiatrist on the board, along with three Board Certified Behavior Analysts and a member of the public

Unfortunately, the new law wouldn’t take effect until January 1, 2015 – much later than we had hoped.

Also, while the bill is very explicit in maintaining existing legal requirements for coverage of ABA beyond 25 hours per week or for patients beginning ABA therapy after age 9, the bill doesn’t facilitate such coverage, which means that conflicts with insurers may continue.  We hope to be able to work constructively with insurers to resolve these issues.

The terms of this final language were negotiated by representatives from the Autism Society of Oregon; Portland Asperger’s Network; Autism Speaks; and the Oregon Association for Behavior Analysis.  We were supported by an attorney with a thorough knowledge of Oregon and Federal mental health parity laws and autism mandates.  We were joined in the negotiations by representatives from the Insurance Industry (including Regence, Providence, and Pacific Source); the negotiations were facilitated by Sen. Alan Bates, SB365’s Chief Sponsor, and supported by an attorney from the Legislative Counsel’s office.

Although the bill doesn’t take effect until 2015, we will continue to work tirelessly in the meantime to help individuals with autism to get the coverage that they are already entitled to.  We will also continue to work to ensure that those patients who don’t qualify for the new streamlined ABA approval approach (i.e., those over age 9, or who want more than 25 hours of ABA per week) can get the coverage mandated by existing law.

SB365 will now be referred to the Ways and Means committee (the budget committee), where the cost will be analyzed.  The bill may be amended further in that committee to address budgetary and structural concerns.

Reminder — please come to the Joint Ways and Means committee hearings around Oregon through April 25thto support SB365 and HB2897!

The Oregon Legislature’s Joint Committee on Ways and Means will be traveling to communities across the state to hear comments from citizens about the state budget.  We encourage everyone to go to one of these meetings to express your support for SB365 and HB2897.

  • Bend: Friday, April 19, 4:30-6:00PM:  William Healy Armory at 875 SW Simpson Ave
  • Hermiston: Saturday, April 20, 1:30-3:30PM:  Hermiston High School Auditorium at 600 S 1st St
  • Portland: Tuesday, April 23, 5:30-7:00PM:  Portland Community College Cascades Moriarty Auditorium at 705 N. Killingsworth
  • Tillamook: Thursday, April 25, 5:30-7:00PM:  Port of Tillamook Bay at 6825 Officers Row

Thanks for your help!

 

Paul Terdal

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