Insurance and Real Estate Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDERS.
SPONSORS OF BILL:
Insurance and Real Estate Committee
REASONS FOR BILL:
To help CT families manage the costs of treating autism.
RESPONSE FROM ADMINISTRATION/AGENCY:
Kevin Lembo, CT Healthcare Advocate supports this measure because it acknowledges Applied Behavioral Analysis (ABA) therapy as a medically necessary treatment that needs to be covered by insurance. Right now, the Office of the Healthcare Advocate needs to represent these cases individually to their insurance companies/managed care organization panels and fight for full healthcare coverage (including psychological treatment, physical therapy, speech therapy, occupational therapy, and prescription drugs). There is a clear need for this coverage to be mandated by the State of CT so these families can be provided with some relief as they try to provide their children with the appropriate care.
NATURE AND SOURCES OF SUPPORT:
Christopher Donovan, Speaker of the House
Martin Looney, State Senator, 11th District
Dr. Kathleen Dyer, Clinical Director/Associate Professor, Capitol Region Education Council know that while there is no cure for autism, early detection and treatment can greatly improve symptoms, development and outcomes. In fact, this early treatment can actually be preventative care for more expensive treatments or continued treatments through the rest of the child's life. One in every 150 eight-year-olds has had an Autism Spectrum Disorder diagnosis. 7 states (Pennsylvania, Louisiana, South Carolina, Arizona, Indiana, Florida and Texas) have mandated healthcare coverage for autism, including behavioral therapies like Applied Behavioral Analysis (ABA). ABA is evidence based behavioral intervention administered by a Board Certified Behavioral Specialist, and it provides these children with better physical and mental health. Doctors can recommend 20-40 hours of ABA therapy per week for autistic children, and this can create astronomical bills for parents to have to pay out of pocket. This mandate will create a very slight increase in health insurance, and estimate it to be only $5 for every $1000 policy, or half of one percent. This additional expense is the moral and ethical thing to do so our healthcare system better serves our families dealing with autism. Cost savings are conservatively estimated to be between 187,000-$203,000 per child from age 3-22 and $656,000-$1.1 million from age 3 to 55.
Jessica Rhodes, School Counselor/Clinician, FOCUS Alternative Learning Center has had first hand experience as a mother of an autistic son and working at an extended day treatment program for school aged children diagnosed with Autism Spectrum Disorder (ASD). Each case is entirely unique and each family has to deal with their own set of challenges. She is here to call on the general assembly to mandate insurance coverage for all children on the autism spectrum. She, like many other parents, has needed to pick up the slack from insurance companies and the school system and prioritize caring for her child above all other aspects of life, including her job, her marriage and herself.
Christine Levine, Clinical Director, Creative Interventions provides ABA based services for ASD. In a study conducted in 1987, 47% of children with autism who received an ABA program had normal levels of intellectual functioning and were participating in first grade without support, as compared to 2% of the control group. ABA is designed to address the core and related deficits of autism: impaired social interaction, impaired communication, a restricted set of interests, aggression, self injurious behaviors, noncompliance, pica, obsessive behavior, stereotypic movements) and builds self help skills (dressing, toileting, washing, cooking, etc.) motor skills and cognitive skills. This very individualized treatment is based off of teaching new skills by breaking down skills into component parts and reinforcing performance of each of those component parts. Levine gives an description of how ABA treatment goes beyond average school teaching practices and home environments to provide specialized training to maximize how and what autism-spectrum children learn. In 2008, a random sampling of children receiving an average 5 hours of ABA therapy per week showed 62% making significant progress (mastered 20 new skills), 15% made good progress (mastered 10-19 new skills), 23% made fair progress (mastered 5-9 new skills) and 0% made limited progress (mastery of less than 5 new skills). ABA therapy and its focus on social, language and life skills helped 100% of these children make progress on learning new skills and helped them reduce their targeted aberrant behaviors by at least 25%.
Matt Katz, Connecticut State Medical Society (CSMS) feels that this bill addresses an issue regarding medical necessity. Insurance companies need to provide comprehensive coverage for autism spectrum disorders, and currently they have been unwilling to handle the routine costs of medically necessary treatments claiming that these individuals had “preexisting conditions” or any other exclusion, making this bill a necessity for families dealing with autism. All people with developmental disabilities, especially children, deserve access to appropriate and affordable medical and dental care. CNN reported that traditional therapies for autism can require $70,000 to $80,000 in out of pocket costs for families with autistic children. These costs are providing developmental therapies that these children need to perform activities of daily living (brushing their teeth and other daily hygienic practices) which will provide them with a greater quality of life.
Shannon Knall, CT Advocacy Chair, Autism Speaks fights for families like hers who are burdened financially by the costs of treating their child's autism. There are parents who need to pay up to $5000 out of pocket to get a medical diagnosis, up to $150 per hour for forty hours of Applied Behavior Analysis every week and possible over $120 per month for prescription drugs. These families need help and they need their child's autism to be handled by insurance companies as a medical condition. She also does not see how insurance companies can insist that this kind of health care mandate will cause premiums to skyrocket. Yes, they will increase, but no more than the difference we were paying in gas only a few months ago.
The personal stories of 21 Connecticut families affected by autism. Each testimony tells a family's unique struggle trying to manage their child's illness medically and financially.
NATURE AND SOURCES OF OPPOSITION:
Susan Halpin, Lobbyist, CT Association of Health Plans pointed out that CT has the 5th highest number of mandates in the country. (with a total of 49 mandates, OLR Report: 2004) Each mandate increases health insurance costs. These costs affect small businesses trying to provide their employees with insurance and cause individuals to have to go without health insurance because it is too expensive.
*25% of the uninsured are priced out of the market because of state mandates.
(OLR Report: 2004)
*Mandates increased 25-fold over the period 1970-1996, an average annual growth rate of more than 15%.
(PriceWaterhouseCoopers Article: 2002)
*For every 1% increase in premiums, 300,000 people become uninsured.
(Lewin Group Letter: 1999)
Eric George, Associate Counsel, CT Business and Industry Association knows that mandates like this bill harm CT businesses' ability to afford of health insurance, especially small businesses. These types of bills will cause CT's health care system to be even more costly and inefficient.
*Health Insurance Mandates increase premiums by as much as 65%.
(Council for Affordable Health Insurance [CAHI] report: 2006)
Reported by: Sarah J. Richards