Advocates, insurance companies are many dollars apart on Missouri autism insurance proposals

Big differences remain on Mo. autism coverage bill

JEFFERSON CITY, Mo. — Despite nearly a year of negotiations, big differences remain between insurers and advocates for autistic children who are urging Missouri to mandate coverage of a costly but promising behavioral therapy.

House and Senate committees each heard testimony Tuesday on proposals that would require insurers for small and mid-sized employers to offer policies covering the diagnosis and treatment of autistic children.

At issue is how much coverage should be offered — and how long it should last — for those seeking “applied behavioral analysis,” an intensive therapy that some parents say produces dramatic improvements in their autistic children.

Advocates prefer a proposal that would require insurers to pay up to $72,000 annually for the treatment of people up to age 21. Insurance company lobbyists say that is too costly and lasts too long.

Blake Williamson, vice president and senior medical director for care management at Blue Cross and Blue Shield of Kansas City, suggested an alternative on Tuesday of providing up to $32,000 annually of coverage for children ages 3 through 7, with lesser coverage for older children.

Legislative committees took no immediate action on the proposals, though Gov. Jay Nixon and legislative leaders alike have declared that autism insurance legislation will be a priority for the 2010 session.

“This is not going to be rushed through,” said Rep. Kevin Wilson, R-Neosho, chairman of the special House Committee on Health Insurance that is considering the bills. But he later added: “I think we can get to a bill that’s fair to everyone and can get through the House and Senate.”

Last year, the Senate passed legislation that would have required coverage of up to $55,000 annually for applied behavioral analysis for children younger than 15. But the bill never received a vote in the House, where Speaker Ron Richard appointed a special committee to study the issue further before the 2010 session.

Autism is a broad term used to describe a spectrum of neurological disorders that affect about 1 out of 110 children in the United States, according to the federal Centers for Disease Control and Prevention. The St. Louis region is near the forefront nationally, with an autism prevalence of about 1 in 83 children, said John Mantovani, the founder and medical director of St. John’s Mercy Child Development Center in St. Louis.

The advocacy group Autism Speaks said 15 states already have laws requiring coverage of medically necessary autism services such as behavioral therapies. It funded an actuarial analysis last year by the consulting firm Oliver Wyman estimating an autism insurance requirement would result in a less than 1 percent increase in the cost of premiums in Missouri.

But insurers insist costs will be higher. Policies offered by Anthem BlueCross BlueShield of Missouri could have to rise by about 3 percent under the legislation favored by advocates, said lobbyist David Smith.

The proposed autism insurance mandate would apply to about 40 percent of the private insurance market in Missouri, primarily those covered through policies for small-to-medium-sized groups. Individual policies would have the option of including autism coverage. Larger group insurance plans often are self-funded and thus federally exempt from state insurance regulations.