SB555 – PacificSource Admits to Being Wrong; Proposes more Autism Coverage

In a short, April 18th, hearing on SB555 (Autism Health Insurance Reform), PacificSource Health Plans announced that they “had been on the wrong side of this issue in the past” and proposed an alternate amendment that refined some of the details of the language, and raised the age limit on ABA from age 11 to age 18.  The other insurance companies present (Regence, ODS) generally expressed interest in supporting PacificSource’s version.

Read that again.  That’s right, the insurance industry proposed RAISING the age limit on ABA from 11 and under to 18 and under, and were generally supportive of SB555.

Emphasis on Early Intervention

This is great, but the price for raising this age limit on ABA is that they want tiered coverage emphasizing early intervention for younger children.  Under their proposal, the limits would be:

• Children 8 and younger:  87 hours of ABA per month (e.g., 20 hours per week)
• Children age 9 to 18:  44 hours of ABA per month (e.g., 10 hours per week)

This is mixed – great for those older children who still need ABA after age 11, not so great for those between the ages of 9 and 11 who would be getting ABA, but only 10 hours per week instead of 20 in the earlier version.

Bear in mind that the hours being cut off would be line therapist hours, not BCBA hours – so you could still have a couple of BCBA hours per week through age 18, and then pay for any extra line therapist hours (typically $15 to $25 per hour) out of pocket.  Not great, but more manageable than having the pay the entire program.

Other Interventions

Again, other interventions for autism (such as speech, OT, psychological care, etc.) would have no age or visit limits.

Next steps

• Sen. Edwards will draft a new version of the amendments.
• There will be another Senate Health Care Committee work session on Wednesday (April 20th, 2011) at 3:00 PM, and presumably the bill will be sent on to Ways and Means at that time.

Senate Health Care Committee Hearing – Wednesday, April 20^th, 3:00 PM

Date:

April 20th, 2011 (Wednesday)

Time:

3:00 PM (Pacific)

Location:

Note that no public testimony will be taken – this will be a vote only.  It will still be helpful to have a crowd in the audience to show our support as they cast this crucial vote.

As in our past hearings, wear something red so that we all stand out as being part of a group.

Please contact Paul Terdal if you are interested in coming to the hearing.  Paul can be reached at paul@terdal.com or by phone at (503) 984-2950.

Posted on Behalf of Paul Terdal, Parent, www.AutismInsuranceOR.org