House OK's bill making insurers pay for autism services

Jul 28, 2010 — The Boston Globe

By Kay Lazar

Jul. 28, 2010 (The Boston Globe delivered by Newstex) -- The Massachusetts House passed a bill yesterday that would require insurance companies to cover a broad range of services for children with autism, a measure that supporters say will help families of such children but that opponents worry will increase health costs, even as other legislation aimed at reining in health spending has been sidelined.
The proposal, which now goes to the Senate, contains mandated coverage for services known as "applied behavioral analysis,'' which include training children with autism and related disorders in social, verbal, and motor skills.
A broad coalition of business groups, insurers, and the Group Insurance Commission, which provides insurance to more than 300,000 state and municipal employees and their families, sent a letter to lawmakers yesterday opposing the bill.
It said there is "limited rigorous research'' on the effectiveness of such autism services and said that the cost of the services, which are often provided at public schools through special education classes, would be shifted instead to the private market, falling heavily on small- and medium- size employers through their workers' insurance premiums. Larger employers are not subject to state insurance mandates and would not be required to pay for these services.
``I worry about mandates that are added in a time of fiscal constraint and that are for relatively new treatment modalities,'' said Dolores Mitchell, executive director of the Group Insurance Commission.
Mitchell said that her budget for the new fiscal year has already been set and that a new mandate would force her to seek additional state funds.
A financial analysis of the bill in March by the state's Division of Health Care Finance and Policy estimated the mandated coverage would boost annual spending for each insured person by between $14.64 and $29.40.
But supporters say the measure would probably add just 83 cents a month, or about $10 annually to each person's insurance costs, based on a similar law passed in Minnesota in 2001.
``Eighty three cents is a small price to pay to include this group of kids under medical insurance to get the services they need,'' said the bill's primary sponsor, Representative Barbara L'Italien, a Democrat from Andover who has a 20-year-old son with the autism- spectrum disorder known as Asperger's.
``Two kids of mine have asthma, and there would not be a question of the services they need,'' L'Italien said. "But for my son who has autism I have always paid out of pocket, and that's wrong.''
She said some studies have shown that about 20 to 50 percent of children who receive appropriate autism services are able to participate in regular education classes, which can significantly cut education costs for taxpayers.
School districts paid $220 million in special education costs for out-of-district placement last year, she said, and the state paid $15 million for early intervention services.
But L'Italien also said that supporters are sensitive to the concerns of small business owners who have been struggling with ballooning health care costs, so the bill was amended to soften the financial impact.
A provision was added that will allow an insurer to drop the new autism coverage for three years if its overall insurance costs rise by more than 1 percent a year. The bill also exempts insurers from paying for in-school services.
``It's not that we don't understand it could have a cost,'' said L'Italien, "but we think it's a reasonable increase to offset the cost to taxpayers down the road.''
Last week, the House passed a bill aimed at reducing health insurance costs, particularly for small businesses. But that bill must still be reconciled with a different Senate bill, and supporters are concerned agreement will not be reached before lawmakers adjourn for the session on Saturday.
If the autism mandate is approved by lawmakers, it would become the latest insurance requirement in a growing list. The mental health parity bill that went into effect last year already required expanded coverage for some autism care.
A report by state regulators concluded that 12 cents of every dollar paid for health insurance in Massachusetts in 2006 went toward 26 mandated benefits, from maternity and mental health care to infertility and diabetes services.
Some of the mandates are also required by federal law, and if those were excluded, the costs of state-mandated coverage would be about 2 to 6 cents of every dollar, the Division of Health Care Finance and Policy study found.

Kay Lazar can be reached at klazar@globe.com.

Newstex ID: BGL-1035-47387899