Autism Insurance Reform in Vermont. Judith Ursitti, CPA Director, State Government Affairs Autism Speaks

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1 Autism Insurance Reform in Vermont Judith Ursitti, CPA Director, State Government Affairs Autism Speaks

2 2001 Snapshot

3 CIGNA HEALTHCARE COVERAGE POSITION Autism Spectrum Disorders/Pervasive Developmental Disorders: CIGNA HealthCare does not cover the following procedures/services for the assessment and/or treatment of ASD because they are considered experimental, investigational or unproven for this indication (these lists may not be all-inclusive): Assessment neuropsychological testing allergy testing celiac antibodies testing erythrocyte glutathione peroxidase studies event-related potentials (i.e., evoked potential studies) hair analysis immunologic or neurochemical abnormalities testing intestinal permeability studies magnetoencephalography (MEG) micronutrient testing (e.g., vitamin level) mitochondrial disorders testing (e.g., lactate and pyruvate) stool analysis thyroid function testing urinary peptides testing Treatment intensive intervention programs for autism (e.g., Lovaas therapy, applied behavior analysis [ABA]) auditory integration therapy augmentative communication devices chelation therapy cognitive behavioral therapy cognitive rehabilitation craniosacral therapy dietary and nutritional interventions (e.g., elimination diets, vitamins) facilitated communication hyperbaric oxygen therapy immune globulin therapy Cigna Vermont Coverage Position 0447 Revised Date. 4/15/2007

4 ABA Therapy is Effective The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research.... Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups. American Academy of Pediatrics

5 2007 Snapshot

6 2008 Snapshot

7 Report to the Legislature to Address Services for Individuals with Autism Spectrum Disorders January 2008 Legislation should be enacted requiring large employers to provide insurance coverage for autism services.

8 2009 Snapshot

9 2010 Snapshot

10 Today..

11 Vermont Law.. the first step. Requires health insurance companies to provide coverage of the diagnosis and treatment of autism spectrum disorders for children with autism between the ages of 18 months and 6 years old who have not entered first grade Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary

12 Includes coverage for: Diagnosis of an autism spectrum disorder - meaning medically necessary assessments, evaluations, including neuropsychological evaluations, genetic testing, or other testing to determine whether an individual has one or more autism spectrum disorders Habilitative or rehabilitative care - meaning professional counseling, guidance, services, and treatment programs, including applied behavior analysis (ABA) and other behavioral health treatments, that are necessary to develop, maintain, and restore to the maximum possible extent an individual s functioning Pharmacy care Psychiatric care Psychological care Therapeutic care - meaning services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists, or social workers The law does not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan

13 Different Dates for Different Plans Effective October 1, 2011 for all state regulated private health insurers Effective July 1, 2012 for state Medicaid plans Federally regulated (ERISA) plans can selfadopt

14 Moving Forward Fought off repeal effort in Implementation delayed instead. Continued fight for expansion to people of all ages diagnosed with an ASD.

15 Additional Resources Self-funded insurance plans are regulated by the federal government under ERISA. Self-insured plans can voluntarily add their own autism benefit. (Contact if you need assistance approaching your self-insured employer about adding coverage.) Contact Department of Banking, Insurance, Securities and Health Care Administration if you are denied: