Pennsylvania Gov. Rendell Law Requiring Private Health Insurers To Cover Treatment For Autism
A bill recently signed by Pennsylvania Gov. Ed Rendell (D) will require
private health insurance companies in the state to provide diagnosis
and treatment coverage of up to $36,000 per year for residents under
age 21 with autism spectrum disorder, the
Philadelphia Inquirer
reports. The law, which is scheduled to take effect in July 2009, also
requires insurers to provide coverage for applied behavioral analysis
therapy that experts say is a key element in treatment of the disorder.
Patients
needing treatments that exceed the $36,000 limit will be eligible for
state Medicaid reimbursements to cover the extra expense. Health plans
that provide coverage to businesses with fewer than 50 employees will
be exempt from the new law. Currently, children with autism can enroll
in the state's Medicaid program, which is managed by the
Department of Public Welfare and spends about $185 million annually on medical-assistance programs for residents under age 21 with autism, theInquirer
reports. Under the new law, those children would be transferred from
the Medicaid program into private health plans that could reduce state
spending by about $13 million in the first year after it is
implemented, according to theInquirer.
Pennsylvania
is now one of eight states to implement laws that require some level of
insurance reimbursements for autism diagnosis and treatment, according
to
Autism Speaks. Nina Wall-Cote, director of the welfare department's
Bureau of Autism Services,
said, "There is definitely a move nationally to usher this type of
legislation through," adding that "Pennsylvania is now on the cutting
edge of that."
Supporters of the new law say that it was
developed to avoid some of the problems faced by other states with
similar laws. The Pennsylvania law clarifies the exact types of
treatments that insurers must cover -- a problem that insurers and
families in California continue to face and that has resulted in
lawsuits, the Inquirer reports. Michael Piecuch, chief of
staff to Pennsylvania House Speaker Dennis O'Brien (R), the law's main
sponsor, said, "We have to start somewhere ... and this population has
been categorically denied insurance coverage" Philadelphia Inquirer, 7/24).
The Kaiser Daily Health Policy Report is published for
kaisernetwork.org, a free service of The Henry J. Kaiser Family
Foundation.