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

Autism Health Insurance Reform: SB365 moving forward for a vote on Thursday

Contents:

  • Update on SB365 – Issues resolved, vote in Ways and Means expected Thursday
  • Update on SB414 – Senate floor vote tomorrow, approval in House expected
  • Next Steps

Update on SB365 – Issues resolved, vote in Ways and Means expected Thursday

A big thank you to everyone who has called and e-mailed the Governor’s office, and contacted their legislators and Ways and Means committee members.  IT WORKED – we got their attention, and we’re going to pass our bill.

Yesterday afternoon, Sen. Bates convened a final workgroup meeting to discuss the bill, including high-level representatives from the Governor’s office; the new Insurance Commissioner; Cover Oregon, the health exchange; many insurance companies; autism advocacy organizations, including Autism Speaks, Autism Society of Oregon, Oregon Association for Behavior Analysis; and myself, among others.

We are expecting the bill to move forward largely as written, but the implementation date for commercial insurance plans will be postponed until January 2016.  The Behavior Analysis Regulatory Board will still be launched in late 2013 to begin licensing and registering ABA providers.  Insurance coverage will apply to public employees in PEBB and OEBB beginning in 2015, as expected in the SB365A bill.

In addition, the Health Evidence Review Commission will be directed to begin a reevaluation of the evidence in support of Applied Behavior Analysis (ABA), starting in August 2013 to finish in August 2014.  If HERC concludes that the evidence to support ABA is now sufficient – and everyone participating in yesterday’s meeting anticipated that it would – then OHP coverage would begin in late 2014 or early 2015.

Although the Ways and Means Human Services subcommittee had been expected to close today, we understand that they have agreed to extend the committee by a couple of days to hear SB365 on Thursday June 20th.  We expect a quick vote to approve the bill.

While the very slow implementation is a disappointment, it is very important to remember that Oregon law already requires coverage of autism “at the same level as, and subject to limitations no more restrictive than, those imposed on … other medical conditions.”  We are confident that this applies to coverage of ABA therapy as a treatment for autism, as courts have found in Oregon and around the country.  A class action lawsuit has already been filed against Providence, and we expect a decision in early 2014 – well before the implementation date of this new law – and we would hope that the Insurance Industry and Insurance Division would apply rulings in that decision to other insurers.

Update on SB414 – Senate floor vote tomorrow, approval in House expected

One of the other bills we introduced this year was SB414, which gives the Insurance Division the authority to seek restitution on behalf of consumers.

Currently, the Insurance Division can’t order an insurer pay a claim – they can impose fines, or ask insurers nicely to pay claims to consumers, but have no authority to actually require payment of a claim.  Since there is no meaningful “private right of action” for a consumer to sue an insurance company in state court (save for the kinds of major federal litigation we’re pursuing against Providence), it’s nearly impossible to make an insurance company pay a claim if it doesn’t wish to do so.

SB414 is now on a fast track for approval.  We had a great hearing in the Senate Rules committee last week, where Insurance Commissioner Lou Savage joined me in explaining the need for the bill to the Senators.  It is scheduled for a vote in the full Senate tomorrow; we are expecting rapid approval in the House.

I would love to see HB3160 pass as well.  As I have written before, HB3160 would remove the Insurance Industry’s exemption from the Unlawful Trade Practices Act (Oregon’s anti-fraud law), and allow private individuals to sue their insurance company in state court for fraud or other illegal conduct.  HB3160 has already passed the house, but is just one vote short in the Senate.  All Democrats except Sen. Betsy Johnson have confirmed their support; all Republicans remain opposed.  If we can persuade just one of those Senators to support the bill, we can get it passed as well.  See my June 13 update for a sample e-mail you can send to your legislators in support of HB3160:  http://autisminsuranceor.org/2013/06/autism-health-insurance-reform-update-on-sb365-ask-your-senator-to-support-hb3160/

The Lund Report has written a great article about SB414, HB3160, and our work on them:  http://www.thelundreport.org/resource/shields_pushes_to_empower_dcbs_as_effort_to_put_insurance_under_utpa_flounders

Next Steps

We’ll let you know how things go in Thursday’s Ways and Means hearing on SB365.  While we hope for smooth sailing from here, we’ll ask everyone to contact their legislators after the Ways and Means hearing to encourage a Yes vote on the House and Senate floor.

 

——–

Thanks for your help!

 

Paul Terdal

This entry was posted in Uncategorized. Bookmark the permalink.

Comments are closed.