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New regulations finalized, licensure bill for ABA providers heading to Governor
(April 23, 2014) -- The Maryland Insurance Administration (MIA) has finalized new regulations that will require coverage of autism benefits, including applied behavior analysis (ABA), for many private plans as well as state employees. Related legislation that would establish a state licensing procedure for ABA providers, meanwhile, is headed to Gov. Martin O'Malley in May.
The new requirements will apply to individual, fully funded small and large group plans, the state employee health plan and coverage purchased through Maryland's health insurance marketplace created under the Affordable Care Act.The coverage includes a minimum of 25 hours weekly of ABA up to agesix, and then 10 hours weekly through age 18.
In addition, psychological care and speech, occupational and physical therapy for the treatment of autism are covered.
However, the regulations require ABA practitioners to be licensed by the state. Because Maryland has no license, legislation was moved through the legislature to create the license and will be sent to the Governor next month. Autism Speaks and other advocacy organizations had urged the state to accept professional certification to speed up the process, but MIA insisted on the need for a state license.
Rather than require autism insurance coverage through legislation, the Maryland Legislature in 2012 chose to create a task force to clarify the state's existing habilitative services statute to provide autism coverage. After a year of study, MIA first proposed regulations in September 2013, then issued a new proposal this year which ultimately was finalized.
Autism Speaks, Pathfinders for Autism and the Maryland Association of Behavior Analysts will host a series of information session in May to familiarize families and providers with the new regulations. Learn more here.
Three different programs serving kids with autism will be rolled into one
WASHINGTON, DC (April22, 2014) -- In a report to Congress,TRICARE announced it will be creating a new Autism Care Demonstration startingJuly 25 that willconsolidate all ABA programs into one uniform benefit for TRICARE beneficiaries with autism.
The new program will launch with the expiration of the current Applied Behavior Analysis (ABA) Pilot for non-active duty family members that has been problematic since its launch last year and has served very few children.
TRICARE intends to transition all beneficiaries receiving ABA services to the new demonstration by the end of 2014.TRICARE reports the new demonstration will extend through December 31, 2016 while the Department of Defense considers coverage of ABA as medical care.
Policy specifics of the new Autism Care Demonstration were not provided in TRICARE's report.Autism Speaks will monitor the release of the program details and encourage TRICARE to publish its proposed policies and seek public input into the process.
"Transparency is important here," said Karen Driscoll, Autism Speaks associate director of federal government affairs and military relations. "Military families need to be able to plan for their healthcare decisions.Engaging with families, service providers, and medical experts is also important to ensure final policies meet the needs of military children in a manner consistent with best practices."
Autism Speaks continues to work with Congressional champions to require ABA coverage for all military children with developmental disabilities, such as Down syndrome,and at medically prescribed levels.Earlier this month, Autism Speaks hosted Congressional briefings for the House and the Senate to highlight the need for the legislation.
Gov. Heineman signs bill requiring certain insurers to cover diagnosis, treatment
LINCOLN (April 21, 2014) -- Nebraska became the 36th state to enact autism insurance reform today when Gov. Dave Heineman signed legislation requiring certain insurers to coverthe diagnosis and treatment of autism up to age 20. The new law, which takes effect with new health policies issued for 2015, requires up to 25 hours a week of behavioral health treatment, including applied behavior analysis (ABA).
Heineman said he was signingthe bill, LB.254, "on behalf of families who meet the challenges of autism every day.” The bill was sponsored bySen. Colby Coash of Lincoln, who has worked for years withfamilies and autism advocacy groups, such as Autism Speaks, in winning autism insurance reform.
“I care about this issue because I have seen the impact that this treatment can have on the future of a child with autism,” saidCoash. “Positive things can happen when they receive life-changing treatment. These families are strong willed and they never gave up on the bill, so I wouldn't either. Today is a special day.”
“This is a great day for Autism families in Nebraska,” said Vicki Depenbusch, Autism Speaks' advocacy chair for Nebraska. “It gives us hope that our children will be the best citizens that they can be.”
Depenbusch's son,Jacob, who has autism, and Heineman (pictured right with Vicki Depenbusch and Coash)metat a parent teacher conferencein 2010. The two have communicated regularly and attended events together over the last four years. Jacob calls himself the “Governor's Buddy.”
The new law requires coverage for speech, occupational and physical therapy, as well as pharmaceutical care for the treatment of autism. No visit or dollars are imposed on those services.
Behavioral health treatment, however, was cappedat25 hours per week andinsurers will be ableto reviewtreatment plans every six months.Certain state-regulated group and individual health policies, as well as state employees, will be covered.
In addition to Nebraska, Utah has enacted autism insurance reform in 2014 and Kansas expanded its 2010 law, which was limited to state employees, tocover its kids with autism. Similar bills remain active in Hawai'i and North Carolina, and legislation that would raise Maine's age cap from 5 to 10 was just sent to the Governor.