Health insurance; mandated coverage for autism spectrum disorder. (SB1062)

Introduced By

Sen. Janet Howell (D-Reston)

Progress

Introduced
Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law

Description

Health insurance; mandated coverage for autism spectrum disorder Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for the diagnosis of autism spectrum disorder (ASD) and for treatment of ASD in individuals from age two to six, subject to an annual maximum benefit of $35,000. This requirement does not apply to individual or small group policies, contracts, or plans, and will not apply to the state employees' health insurance plan. This measure will not apply to an insurer, corporation, or health maintenance organization if the costs associated with coverage exceed one percent of premiums charged over the experience period. Amends § 38.2-3418.17, § 38.2-4319, of the Code of Virginia. Read the Bill »

Outcome

Bill Has Passed

History

DateAction
01/11/2011Prefiled and ordered printed; offered 01/12/11 11103631D
01/11/2011Referred to Committee on Commerce and Labor
01/31/2011Reported from Commerce and Labor with substitute (14-Y 0-N) (see vote tally)
01/31/2011Committee substitute printed 11104856D-S1
01/31/2011Rereferred to Finance
02/02/2011Reported from Finance (15-Y 0-N) (see vote tally)
02/03/2011Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/04/2011Passed by for the day
02/07/2011Amendment by Senator rejected (11-Y 29-N) (see vote tally)
02/07/2011Read second time
02/07/2011Reading of substitute waived
02/07/2011Committee substitute agreed to 11104856D-S1
02/07/2011Reading of amendments waived
02/07/2011Amendments by Senator Newman rejected
02/07/2011Amendment by Senator Wagner rejected
02/07/2011Reading of amendment waived
02/07/2011Amendment by Senator Watkins rejected (11-Y 29-N) (see vote tally)
02/07/2011Engrossed by Senate - committee substitute SB1062S1
02/08/2011Read third time and passed Senate (28-Y 11-N) (see vote tally)
02/09/2011Placed on Calendar
02/09/2011Read first time
02/09/2011Referred to Committee on Commerce and Labor
02/14/2011Impact statement from DPB (SB1062S1)
02/15/2011Reported from Commerce and Labor with substitute (18-Y 4-N) (see vote tally)
02/15/2011Committee substitute printed 11105296D-H1
02/16/2011Read second time
02/17/2011Impact statement from DPB (SB1062H1)
02/17/2011Read third time
02/17/2011Committee substitute agreed to 11105296D-H1
02/17/2011Engrossed by House - committee substitute SB1062H1
02/17/2011Passed House with substitute (71-Y 27-N)
02/17/2011VOTE: PASSAGE (71-Y 27-N) (see vote tally)
02/17/2011House substitute agreed to by Senate (28-Y 8-N) (see vote tally)
02/17/2011Reconsideration of House substitute agreed to by Senate (38-Y 0-N) (see vote tally)
02/17/2011House substitute agreed to by Senate (29-Y 8-N) (see vote tally)
02/17/2011Enrolled
02/17/2011Bill text as passed Senate and House (SB1062ER)
02/18/2011Signed by Speaker
02/21/2011Impact statement from DPB (SB1062ER)
02/21/2011Signed by President
03/17/2011Impact statement from DPB (SB1062ER)
03/26/2011Governor's recommendation received by Senate
04/05/2011Placed on Calendar
04/06/2011Senate concurred in Governor's recommendations #1, #2, #3, #4 (39-Y 1-N) (see vote tally)
04/06/2011Senate rejected Governor's recommendation #5 (16-Y 24-N) (see vote tally)
04/06/2011Reconsideration of Governor's recommendation #5 agreed to (40-Y 0-N) (see vote tally)
04/06/2011Senate rejected Governor's recommendation #5 (15-Y 25-N) (see vote tally)
04/06/2011House concurred in Governor's recommendation Amendments # 1-4 (84-Y 10-N)
04/06/2011VOTE: ADOPTION (84-Y 10-N) (see vote tally)
04/06/2011G Governor's recommendation adopted in-part
04/06/2011Communicated to Governor
04/06/2011Reenrolled
04/06/2011Reenrolled bill text (SB1062ER2)
04/06/2011Signed by President as reenrolled
04/06/2011Signed by Speaker as reenrolled
04/29/2011G Approved by Governor-Chapter 878 (effective 7/1/11)
04/29/2011G Acts of Assembly Chapter text (CHAP0878)

Video

This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 3 clips in all, totaling 24 minutes.

Duplicate Bills

The following bills are identical to this one: HB2467.

Comments

Paul Griesbach writes:

Thank You Senator Howell :^)

Teresa Champion writes:

This bill is the first step for insurance coverage for the diagnosis and treatment of autism. Autism is treatable and children can improve but insurance companies deny reimbursement at their own discretion. Twenty-three other states have passed similar legislation. this is a medical diagnosis that deserves medical coverage for the treatments that doctors prescribe.

Laura Phillips writes:

Senator Howell- Thank you for introducing this bill. As a professional working with kids with Autism, I see how inconsistent insurance companies are when dealing with the diagnosis of Autism. Autism is a medical condition. Our kids with diabetes, cerebal palsy, down syndrome, etc. are not discriminated against.
It is time for Virginia to pass this law and treat our kids with Autism for a stronger tomorrow.

Brett D Wills writes:

Distinguished Delegates of the House appropriations commitee,

I apologize for sending this identical email to you all, and for its length. I really wanted to come to Richmond again and to meet with each and every one of you but the weather is affecting my childcare availability and thus prohibiting me from telling you all of this in person. Given your limited time in session perhaps it is better to communicate in writing after all.

My own Delegate, Steve Landes, is among the members of the House Appropriations committee which I write today. I am asking him and the rest of you to please do me the favor of considering giving your support to HB2512 and HB2467

Delegate Landes and Senator Hanger have made me VERY proud to be a fellow fiscal conservative represented by them this year by writing the proposed legislation to add much needed medicaid waiver slots so that MORE Virginians with disabilities can receive cost effective serviced in their homes with their own families or with sponsored and supported families rather than being confined to institional care at higher state taxpayers expense in order to....or as is often the case, INSTEAD of receiving needed services.

My name is Brett Wills. I am a Virginia taxpayer and the father of a 9 year old child who remains nonverbal due to his autism AND the lack of appropriate early interventions and habilitative therapies in our locality.

But in your collective role as members of the House Appropriations committee, I don't expect you to consider his quality of life as you consider Bills HB2512 and HB2467 and how they will affect state spending, which I believe is what you are going to have to consider.

What I want you to understand is that Aaron will be a MUCH more expensive citizen to the commonwealth of Virginia taxpayer than he would have had to be.

Autism isn't curable, but its severity can be greatly lessened by pro-habilitative therapies at an early age.

Lessening the severity is important not just for quality of life but in terms of efficient public expense. It can mean a savings of 50,000 dollars a year in mixed funds to a school district per student, if mainstreaming by second grade is possible or if private day schools are not needed. More than that if residential confinement is avoided.

It can mean less community based services needed to allow for independent living. It can mean independent living is even possible without the need for community services. It can mean the difference between supported living with community-based services as an adult being possible as opposed to the worse case scenario, confinement to a state hospital for life.

Please allow me a moment to explain the nature of autism strictly as it affects my own son...and his family...and his teachers...and people who sit next to us in Church..and people who interact with us at the grocery store or McDonalds..and of course, Virginia's taxpayers who trust you folks with their money for the greater good.

One factor of Autism is that it keeps a parent REALLY busy. But I have managed to find time to study up on some things since then, and as a paint Salesman at the Lowe's store in Staunton I have learned a valuable skill that I hope will be useful in this current situation. I know how to explain things that SHOULD be obvious but may not be to folks that are (hopefully) way smarter than myself. As a farmer, simply put, I understand when it is raining and when it is not. But we will come to that in a minute.

This is what I know now that I needed to know then. The details of this are in the National Stadards report created by the Autism Society of America, the state JLARC on Autism in Virginia released last year, and the report "Educating children with Autism" requested by order of the president ten years ago from the National accademies of science.

But I'm gonna try to simplify all that for you since I'm not as smart as all those guys.

Between the ages of 24 months and age 48 months a child makes a quantum leap in communication and development.

My younger child, Bryan, went from uttering the single word "fry" at age two, to saying "may I PWEAZE have some FRENCH FRIES"? at age 4

My older child, Aaron, did not have verbal communication of any kind at 24 months including receptive language. He went from grabbing a single fry from my tray at 24 months to trying to tackle complete strangers in order to take THEIR fries at age 4.

Behavior was his language, and he was making a quantum leap in using his behavior as language for the purpose of getting stuff. But it wasn't...appropriate. At all.

Now at age 4 my county finally agreed with us and the doctors that Aaron really DID have autism and sent him to a neighboring school district to attend their preschool for autism...this was the first time that he had instruction from a staff who understood how to instruct nonverbal children using the principles of applied behavior analysis. He learned receptive language and began using a Picture Exchange Communication system to make sentences asking for things. He continues to use this and with a lot of hard work on everyone's part including his own he now at age 9 Aaron can communicate on level with a neurotypical 2 year old. We all learn slower between age 4 and 40 than we do between 2 and 4. I will spend the rest of Aaron's education trying to get him up to an age 4 level of communication, because someone with the communication skills of a four year old has a better chance at living independently. (those of you with children of this age probably understand that fact intimately....someone with the communication skills of a six year old could probably hold elected office)

BUT.....as much work as all of that is and as worthwhile as it is...I mean, I'm fighting to educate him to a level where there is less chance of him being sent to die in a state institution (at state taxpayer expense) after I'm gone....this is his second language. Behavior is his first. BAD behavior is his first. So his first reaction to every want and need is a behavior that must be redirected...beacuse he learned it during his quantum leap years...and he is learning appropriate communication during his "slow" learning years. And this lack of appropriate communication is what most affects his development.

That is the situation that I am citing when I say that he will be a more expensive citizen to the taxpayer than he would have had to be.

But not NEARLY as expensive as he would have been had he NEVER received appropriate instruction. His teachers continue to do a fine job. But again, they require more resources than would have been otherwise necessary, and they won’t be able to help him progress as far, as he would have had he received appropriate medically necessary services earlier in life.

Now....if educators and doctors understand the need for early intervention for autism, we have to ask ourselves WHY isn't it happening in Virginia, in every locality. why do services and resources vary from one zip code to another? Why does a child in Harrisonburg receive 40 hours a week of intensive instruction through FAPT funding via the Matthews center at age three while a child 20 minutes south of there might get a half-hour a week of "speech lessons" from an unsupported speech teacher who has never worked with a child who has nonverbal autism?

Simply put, no one can agree on who is going to PAY for it.

Also, all of these fractured entities, even with what they DO accept as falling within their funding, are trained to look at an ANNUAL budget. Anything that saves money THIS year is what we give ourselves credit for, Even if that is actually a long term increase in spending. I call this type of budgeting "deficit thinking". This isn't so much someone refusing to participate in an investment oppurtunity that might yield results as it is someone proclaiming they can't afford to fix the leaking roof....even as the plywood and the rafters and the sheetrock and finally the carpet and floor sheathing and floor joists and foundation all incur damage that needs further repair at much higher expense.

One thing that insurance companies have gotten REALLY good at in recent years is preventive care, early diagnosis and early treatment. I don't think it will offend any of you folks if I suggest that, in this way, they are now a little bit less likely to fall victim to "fracturing of cost analysis" or "deficit thinking" than any current governmental entity.

This is why we TRUST them to do right by our kids with Autism covered by their policies. Once we make it their problem at all.

Now,

For the average consumer of private insurance the cost increase in premiums will be negligible….around 5 to ten dollars per YEAR per family policy if what we have seen in other states that passed this legislation holds true. And since Virginia policy holders are also Virginia taxpayers there will be a tradeoff in private investment against the social and budgetary costs of having a segment of the population grow up to be more disabled than they would otherwise be.

But because there is a separate bill to cover state employees (making the one for everyone else revenue neutral) and because the state pays a portion of the employees premiums…there is a small budgetary increase in the short term.

Remember what I said about paying for fixing that leaking roof?

And remember what I said about being able to tell when it’s raining?

Autism has increased but most alarmingly the specific type of autism that my own son has, sever nonverbal autism, has increased. In other words, it’s raining. And with the fractured and disproportionate response we have across the state, the roof is leaking in some places more than others but the whole thing needs fixing.

In the days ahead you will all likely hear from insurance company lobbyists who oppose this bill. They will have a lot to say but as your taxpayer I urge you to understand what they MEAN.

Insurance industry lobbyist: “PLEASE let us continue to operate with a higher profit margin than we do in 23 other states where we have to provide these services! Please side with our stakeholders over the interests of Virginia’s taxpayers, children, future generations, and system of care. Please don’t think about the financial rewards to addressing this problem through private means…more resources for indigent care, more private money paying for highly-qualified therapists and Behavior analysts and clinicians who will FOLLOW our money to Virginia and provide these services and add their decent salaries to the roles of Virginia taxpayers. Please don’t think about the big houses and offices they will want to build, the boost to the local economies, the increased tax revenues, etc…..please just focus on the cost of increased state employee premiums. Your citizens will be worse off for it….but our employers will make a teensy bit more money that our own high salaries are leveraged against.”

Now there’s another situation where it’s a handy skill to be able to tell when it’s raining…and when it’s not. That ain’t rain, folks.

As Aaron’s dad, who knows Aaron will need more help from the state than he should, as Bryans dad, who will be part of a generation of hardworking taxpayers struggling to care for disabled family members, as one who can see that there are SO many more Bryans and Aarons being born every day, I’m asking you all the favor of lending your support to these bills. I’m asking you to see the truth of the matter, which is that both of these bills are revenue SAVINGS.

Thank you all for your consideration of this matter.

Brett Wills
Bryan and Aaron’s Dad

2370 Barrenridge RD Staunton VA 24401

Don Kilian writes:

Definitions are far, far too broad and loosely worded. The term "autistic spectrum" is dangerous, it can include children who are merely shy and temporarily a bit slow in development at one end, or it can refer to enormously disabled children. It is potentially wildly expensive to write a blank check for all children anywhere on this spectrum. It is also unwise to fail to require a psychiatric physician or licensed mental health provider to provider evidence of accurate diagnosis and evidence of need for a well defined treatment plan. The bill is full of expensive loopholes and exploitable risks. The enthusiasm of the supporters, while humanly very understandable, is at odds with the need for legislation and state funding to be clear, well defined, and well thought-out. Our state's limited mental health dollars need to be very, very carefully divided amongst those groups who need them the most, not given away in a moment of enthusiastic compassion to a well organized, articulate, insistent advocacy group.

Susan Lawrence writes:

Don - wish male citizens had the same level of accountability before they got their Viagra prescriptions filled and paid for by insurance. Maybe the men are just tired, overworked, drank too much that night, etc. The diagnosis needs to be better defined with services divided among those groups who need them the most, not given away in a moment of enthusiastic compassion to well organized, articulate, and insistent men who may just be leading a wild lifestyle and wishing for a higher level of performance. Why is Viagra considered to be treatment for a medical vs. relationship issue? In a current state administration of "high morality" shouldn't we at least require that all gentlemen receiving Viagra be certified to be a member of a heterosexual marriage? Otherwise aren't we just encouraging a lack of family values? And we should require a psychiatric evaluation in case it is just all in their heads. Or maybe we just let everyone work it out with their physician and provide physicians with a minimal amount of respect and trust to do the job they trained for years to do for their patients. Autism is a medical issue with a community wide impact. The treatment is research based and children do get better, at all level. There is a spectrum, because without appropriate early intervention children start sliding down the spectrum. I don't have a child with autism, but have been an educator for over 20 years and seen children regress without assistance, and seen the horrors of residential placements forced on families with children who never learned to communicate. If you think therapy is expensive, you don't realize that residential costs $1,000 per day, per child - that's $365,000 a year. Suddenly that $35,000 cap looks small doesn't it. I hope all our senators will support this bill today without changes. We are in the middle of a crisis with an unknown cause, but we do have a treatment. Let's get it done today! This is a great first step!