A bill filed in the state House this year would require large health insurance plans to cover as much as $50,000 a year in applied behavior analysis treatment for autistic children ages 1 though 6.
House Bill 159, sponsored by Rep. Jeff Greer, D-Brandenburg, was approved unanimously last week by the House committee on banking and insurance.
It also would require $12,000 in annual coverage for autistic people ages 7 through 21. Smaller insurance plans would have to cover as much as $1,000 a month in autism treatments.
Greer hopes the bill will be heard on the floor of the House this week.
A similar Senate bill, which does not cap the amount that insurance companies would be required to pay, has not come to a vote in the Senate Appropriations and Revenue Committee.
Applied behavior analysis methods are sometimes used in public schools, but full-time treatment of autism with one-on-one certified behavior analysts is rare and expensive, said Shelli Deskins, director of the Highlands Center for Autism in Floyd County. Tuition at Highlands, a private, non-profit day school, is $60,000 a year. Nationally, similar programs can cost as much as $100,000 a year.
As more children are diagnosed with autism spectrum disorders every year — a study released in December by the Centers for Disease Control and Prevention found that in the United States, about one in 110 children is diagnosed with an autism spectrum disorder (previous estimates had put the number at one in 150) — insurance companies have resisted paying for the more expensive treatments, Deskins said. Sometimes, insurers will pay for specific aspects of treatment, such as speech therapy or pharmaceuticals, but often not for applied behavior analysis, she said.
In 2007, two similar bills were sent from the House to the state Senate but died in committee. Several bills have been attempted since then without much success. Thirteen states recently have mandated coverage of autism treatment. Indiana has no cap on coverage, Greer said.
"What we did differently is we got agreement," he said.
Insurance company representatives had input into the bill, and none spoke against the bill in the Banking and Insurance Committee hearing, Greer said. Humana and other insurance interests have donated to the election campaigns of Greer and co-sponsor Rep. Scott Brinkman, R-Louisville.
"Any mandate can have the unintended consequence of increasing the cost of health insurance for consumers and businesses. We've expressed this concern and continue to work" with Greer and Brinkman, said Tony Felts, spokesman for Anthem Blue Cross and Blue Shield in Kentucky.
The fact that House Speaker Greg Stumbo is from Floyd County and has helped raise money for the Highlands Center for Autism in the last year doesn't hurt the bill's prospects, Greer said.
Representatives also worked with autism advocates. Autism Speaks has tried before to get expanded-coverage legislation passed, said Anne Gregory, Kentucky's community advocacy chairwoman for the group. She said she liked that the Senate bill did not cap coverage, but the House bill seems to be getting more attention.
She said she thinks the House bill is good, but she worries about the $12,000 cap for coverage of older children. Autism Speaks research has shown that similar bills have increased insurance premiums by less than 1 percent in other states, and it's expected to hold true in Kentucky, Gregory said.
The bill also includes language to form a state board that would certify behavior analysts, an important step in showing that autism is a medical diagnosis with a standard of treatment, Gregory said.
"I'm just glad there's something moving in Frankfort," she said.