Massachusetts Passes Autism Insurance Legislation

By Allison Chapman

Treating autism should not have to depend on how large a pocketbook you have or how deep your pockets run.  Massachusetts State Representative Barbara L’Italien agrees with such sentiments, as she decided to introduce legislation to level that treatment playing field for MA residents by requiring insurance companies to cover autism. 

What a concept, requiring the insurance companies to pay for treatments for a medical diagnosis. Hmmmm… Isn’t that what we pay our insurance premiums for?  It seems draconian that such legislation has to be laid out in meticulous form and become law before these kids can have a chance with the right medical, therapeutic and behavioral treatment avenues, but nonetheless it is necessary. 

On August 3, 2010 Rep L’Italien and Senator Berry’s bill became a law when Governor Patrick signed it. With not enough room at the statehouse for those who wanted to view this historic event, the signing was done at the great Fenway Park.  I can’t imagine a more fitting place to hit a home run for families who really need it. 

Most of us with children with Autism can understand why a baseball stadium was needed to house the huge growing community of families with a child or children with autism.  It’s an epidemic, or at least a national health crisis but we have yet to actually hear those words officially from the right Government agencies.  There are still too many trying to say that better diagnosing and expanded criteria are the reasons for all of the new flapping, verbally repetitive and unresponsive children we see more and more everywhere we go in public. Thankfully Rep. L’Italien did not need to be told what this diagnosis can do to a family or how much more prevalent it is, because she is also a parent with a child on the spectrum.  I’ve worked with her on other legislation but not this particular bill.  She readily understands the predicaments of ASD and the medical/therapeutic treatments that are needed for our children.  I had confidence in her that she would fight for the right verbiage needed to be entered into such a necessary piece of legislation. 

The bill includes coverage for the diagnosis and treatments of autism spectrum disorders.  Care provided, prescribed or ordered by a licensed physician or psychologist for a person on the spectrum that they deem as medically necessary must be covered.  There is no age restriction for any of these treatments to end or begin.  Specifically they mention habilitative and rehabilitative care such as ABA, but not limited to, pharmacy care, therapeutic care including speech, OT and PT, psychiatric care, and psychological care.  

In reading through the bill I had some questions which were graciously answered by Rep. L’Italien’s staff.  I wondered about augmented communication devices, and a few other items. They have been gathering information on things missing or not completely laid out in the bill, and will try to work with the Division of Insurance hoping to make it even more comprehensive and clear.  I also wanted clarification of which kind of Medical Doctors can deem medically necessary treatment; there is not a restriction other than that of having their license.  I did not want treatment options left up to one medical organization and thankfully this bill does not make the decisions for you.   

So from what I’ve read and have been told there are only a few cons and most are being worked on.  There is a 3 year opt out option for insurers who estimate it will raise their premiums more than one percent per year.  But that is going to be decided by independent review not the insurers themselves. There was also not a specific mention for augmented communication devices which are not covered under all plans fully.  But they may be able to add some language along those lines because they are necessary for some kids for habilitative and rehabilitative care.  

Because of this bill your child will no longer be denied health treatment if it’s deemed medically necessary because of their diagnosis of autism, I’m sure that alone is a breath of fresh air for many. 

To say that it will be helpful to countless families is an understatement and beyond even what I realized.  I knew, the ABA, speech, OT, PT and non discriminatory medical care, were desperately needed, but little did I know people were still having trouble getting an actual diagnosis because of lack of proper insurance coverage.  Last winter, I met one of the special Ed bus drivers picking up some of the kids from my son’s program.  He stopped me a couple of times when he saw my NAA and TACA bumper stickers, begging me for help to try and find someone to diagnose his Grandson.  He was over 3 ½ (too late for EI), not talking, screams a lot, little eye contact, lots of repetitive behavior, etc.  Children’s Hospital Boston was not able to accommodate them because his daughter’s insurance would not cover the assessment process.  I just hope he was watching the news and is aware of his daughter’s new options beginning January 1st of 2011, of not only getting an assessment, but receiving the services her son desperately needs. 

Thank you to Massachusetts Representative Barbara L’Italien and Senator Fredrick E Berry for sending one over the Green Monster for our kids.   

Allison Chapman is an autism advocate and mother of a son on the spectrum. She lives in Massachusetts.

Comments

[Phyllis]

I live in Massachusetts and even though Massachusetts passed this law, if your insurance plan is a self funded plan, they don't have to follow the mandated state laws. They follow erisa rules. Our insurance plan is self funded and they don't cover autism related services for children over the age of 3. I have a child diagnosed with PDD-NOS and we are unable to get aba covered by our insurance. Other people must be going through this same thing...What do we do now, except pay for services out of pocket?

[treegirl]

Again......... This is why parents MUST make sure their children get proper medical assessment and treatments before they allow their child to be labeled. The insurance companies are using the label to deny medical treatments. It is a huge scam. Parents must prove their children are sick! The hold the insurance to the fire to fix it. We did it and chelation is covered. Defend your children by preventing negligence of the label.

[Jennifer]

And isn't Autism Speaks number one phoney, Peter Bell, a resident of NJ? How come he isn't out there voicing concern and pointing out the problems of the insurance reform in NJ.? Or is just the image making part that's important? All jerks like Bell care about is praise from people for gettng the insurance through. Little do people realize is that it sounds like a hollow victory. Autism Speaks wastes money on this BS!

[Jennifer]

jlsmith-thank you for pointing all of this out. People think this is as easy as just picking up a telephone and telling an agency or a BCBA that they are all set to go for services. Far from it. There will be many hoops to jump through and this will all be BS as you say. The Autism Speaks assholes in Mass. running around acting like this is a huge victory are so clueless it's laughable.

[jlsmith]

I hope this truly is good news, because the sad truth is that in many states all this autism insurance reform is a bunch of bs. In NJ, the exemptions for coverage are monstrous--an estimated 85% of families are not covered. Of those that are, the insurance companies have incredibly high deductibles and copays that apply to the coverage, and ridiculous conditions for providers--such that for nearly everyone, the new law is actually a STEP BACKWARDS. My BCBA was contacted by 2 insurance companies that were only willing to give her $27/hour for ABA, and required that all ABA be provided by her personally (not by professionals she supervises without the BCBA certification). She was told by both insurance companies that if she balanced-billed the families, she would be prosecuted under criminal statutes. So this is what is called "insurance reform" in NJ, that we are all supposed to be celebrating. It is definitely NOT better than nothing, as people like to say, because friends and families readily believe that the coverage is real and not illusory, and it just creates another thing about which I have to educate people.

Sorry to be negative, but I am really sick of our community being continually duped...hope things are better in Mass. than in NJ, and my hat is off to you for all your efforts.

[Kristine]

Good article on some good news! I totally agree with your perspective that this is a bill that should not be necessary but obviously is. I bought our children health insurance because if they got sick, it would be covered. My son got sick, and the insurance didn't pay one dime. How is that okay? It's not, it's fraud. If there needs to be a law to point that out, so be it.

[Allison]

I'm not saying that this is the magic pill or end all be all for insurance mandates. It's not going to cover biomed or does it concentrate on the comorbid underlying conditions in autism. But it will help the bus driver get his Grandson diagnosed and treated with the behavioral therapy he needs. There are too many families like these left to fend for themselves and opportunity outcomes entirely depends on their pocketbooks.

Hopefully in the future the underlying medical issues in autism will be admitted and treatments for these underlying medical conditions will be recognized and covered. For now it's behavioral treatments, speech and ot and the most basic need of procuring a diagnosis.

[Media Scholar]

This bill was designed to let insurers off the hook.

You obviously don't know what you have done since you are here reveling about it.

The truth is this bill was going to be enacted whether or not Gumbo the Giant Pink Elephant showed up on the doorsteps of the Massachusetts legislature and trumpeted Joshua Fit The Battle of Jericho loudly through is polka-dot trunk.

[Cheryl Gaudino]

I know that this bill is not perfect but at least it is a step in the direction. When Ryan was diagnosed 11 years ago, the first line of the Exclusion list in my Blue Cross/Blue Shield policy was Autism. What's unfortunate is that it has taken 11 years and state legislation to force insurance companies to do the right thing and stop the discrimination. Kudos to Barbara L'Italien and the crew at AFAM.

[Jayne Chapman]

Massachusetts has always lead the nation in progressive areas - this is great news!

I am Allison's mother-in-law and know what a relief this is to that family and so many others in Ma.

I know that one of the reasons so many marriages break up when there is a child with Autism is due to the high medical costs. Hopefully, this new law will help to keep some of these families together.

I wonder if the costs of supplements will be covered as those costs are insane!

[Janet Sheehan]

Great article, Allison! may ARICA truly be the "shot heard round the world"...or at least, our country anyway! But I am wondering how this ties into Early Intervention Services, as Molly said, who will get billed? hopefully they won't "pass the buck" and try to defer services to the insurance company, and vice versa. Will you be able to supplement services that the public schools are not willing to provide? will this encourage them to offer less? It will be interesting to see how this all plays out.

[Allison]

Here you go Media Scholar
http://www.mass.gov/legis/laws/seslaw10/sl100207.htm
Barbara's office is forwarding me the new augmentive communication legislation today, I'll post that link when I get it as well.

[Alison MacNeil]

It pains me no end to visualize corporate fat cat insurance execs wincing at 'HAVING TO' cover our kids for about 1/5th of what they need. Hopefully this will put some money back in the pockets of financially strapped parents freeing them up to pursue more of the other stuff their kid's need for treatment. Thank you Barbara l'Italien for making this happen.

[Media Scholar]

Where's the link to the actual legislation?

May I have it posted here please?

[Teresa Conrick]

Thanks, Allison for some good news! Yes, we would like more medical help (HBOT, neurofeedback, detoxification, saunas, etc) but this is a first step in reaching that goal. Representative Barbara L’Italien sounds like a wonderful advocate for the children of Massachusetts.

[dana read]

I'm curious how they're going to handle this and the augmentative piece because a one or two day training does not in any way qualify a teacher or therapist to assess a child for the proper device or train them on it. If the school's have the opportunity to cheap out on the augmentative piece, they will and it will be to the detriment of our children. I commend all of the reps who made these bills happen but I don't have high hopes given my experiences within my own district and those of some of my friends. Here's to hoping.

[Upsides and downsizes]

It's wonderful news, a great start and many thanks to the amazing advocates in Massachusetts who worked so hard to see this bill passed.

Unfortunately, employers and corporate leaders in Massachusetts were generally hell bent on stopping this bill. We've wondered if this was the reason my husband was laid off precisely 17 hours before the bill-- which everyone knew Gov. Patrick would pass-- was signed into law. My husband was given no reason for the layoff and most of his colleagues were pretty shocked. Awards, book publications, new contracts-- he'd been at the firm without negative incident for nine years.

If it works out, the "departure" will actually be a good thing in many ways. It's very difficult for autism parents to leave corporate jobs, even ones they're not perfectly happy in, so it was a push to launch an independent operation. But we're questioning whether there's generally been a forced exodus of autism parents from the corporate workforce right around the times autism insurance coverage has been mandated in certain states. It would be a pretty interesting civil rights issue if this were so. Layoffs are hard for everyone, but we know that many autism families aren't making it and not everyone can simply start their own business or fall back on savings or family.

[Robyn Beliveau]

Wonderful post Allison. Not only is this legislation extremely important in protecting the rights of our children, but also in recognizing the growing population of children being diagnosed with autism and ASD. Thank you for continuing to work with our government leaders to ensure that all children have a chance at quality care.

[Allison]

Just went on Barbara L'Italian's facebook to give her the link to this piece and saw this bit of good news....

"Last Tuesday the Governor signed Rep. Garrett Bradley and Sen Cindy Creem's Augmentative Communication bill into law (with a bit of help from me). It is critical that we adress the communication needs of non-verbal students and that our MA teachers are equipped to handle them in the classroom."

[dana read]

While I don't agree with government "meddling", I do agree with all insured children (whether it's funded publicly or privately) having access to medical care, which is what this bill is about. Children and families with autism should not be discriminated against, denied coverage and be at the mercy of greedy insurance executives. This is a good bill. It's not perfect but it is more than we had before and a step in the right direction. Re. augmentative communication, Rep. L'Italien also just helped push through a bill that was signed yesterday by the governor requiring public schools to provide training to their teachers in assistive communication. I haven't read it yet, but again, more than we had before and certainly gives parents more "teeth" in advocating for our kids. Thanks so much Allison for taking the time to write this!

[Mollie]

Anyone know how the school districts are going to handle this? I can just imagine them all telling parents to bill their insurance company for ABA and drag the process out even more. They already do a horrible job at being responsible for services, this will muddy the waters even more.

[ObjectiveAutismDad]

Matin, I would generally agree with your statement -- as in the case of your statement about vaccines. However in this case the state governments are starting to step in because of active discrimination against families of children with autism.

It is seldom that liberty is lost all at once (Hume). This is not one of those cases.

[Martin Cowen]

I do not agree that this governmental meddling in the insurance business is a good thing. It is precisely because government believes its business to be "everything" that vaccines are mandated and some treatment options are barred. Freedom, voluntary contracts, and property rights are what we need, not more government regulation.

[Maurine Meleck]

Thanks for this report, Allison. I hope the "medically necessary" isn't the same "catch all" phrase that also occurs in SC and so many other states. Here a doctor might deem an oxidative stress test necessary or B12 shots, but insurance will turn it down as experimental. The other services such as ABA, O/T etc certainly are an improvement over what was available for coverage before.
Maurine