California is officially the 28th state to enact autism insurance reform by signing SB.946, which requires coverage of proven behavioral treatment therapies starting in July 2012.
"Courage and common sense have prevailed as Governor Brown has chosen to side with California families and taxpayers, rather than the health insurance lobby," said Autism Speaks Co-founder Bob Wright. "Autism Speaks singles out Senate President Pro Tem Darrell Steinberg whose unwavering leadership and commitment led to this success."
Authored by Senator Steinberg, SB.946 clarifies settlements negotiated by the Brown administration last summer with two major health plans that behavioral health treatments, such as applied behavior analysis (ABA), are eligible benefits with no caps on age or amount of benefits. The settlements initially appeared to provide the needed coverage, but contained a flaw that substantially negated their intended impact, requiring the legislative remedy provided through SB. 946.
The law began taking effect July 1, 2012, as health plans renew policies and sunset in 2014. By virtue of the early intervention provided through ABA, California taxpayers are expected to save $140 million a year in special education and social service costs, according to an independent analysis by the California Health Benefits Review Program. In addition, the improved access to ABA therapy could create at least 20,000 new jobs.
"This is a victory for the thousands of California families who have had to pay out-of-pocket costs for autism treatment considered medically necessary," said Steinberg. "I commend the Governor for signing SB. 946 and adding California to the long list of states mandating that health plans pay their fair share. This day would have never happened if it were not for the countless families and advocates who have been working tirelessly on this issue for many years. Our work is not done. As soon as our economy improves I will work to ensure every child, every young adult, and every family in California has affordable access to this therapy."
The new law explicitly preserves the obligation of health plans and insurers to provide services under California's existing mental health parity law, through which many families have been able to secure coverage for other treatments such as occupational therapy, speech therapy, physical therapy, and treatment of co-morbid physical health issues.
Thousands of California families, in the absence of insurance coverage, have been forced to pay out-of-pocket or rely on taxpayer-funded programs for behavioral health treatments, which can cost $50,000 a year or more. Autism Speaks has helped lead the fight in statehouses across the nation to end such insurance company discrimination. This year alone, laws have been enacted in Arkansas, Virginia, West Virginia and Rhode Island; and a bill passed this summer by the New York Legislature awaits Gov. Andrew Cuomo's signature.
Since 2006, the prevalence of autism has risen to 1 in 110, including 1 in 70 boys, prompting the national Centers for Disease Control and Prevention to call autism a public health challenge. Estimates of the annual cost of autism to the nation have ranged as high as $90 billion. The number of California children with autism has not been calculated precisely, but estimates range at 30,000 children.
"The use of early intervention treatments, such as ABA, can substantially increase a child's independence, thereby reducing future taxpayer costs for special education and social services," said Peter Bell, Autism Speaks' executive vice president for programs and services. "In states that have enacted autism insurance reform, actual experience has demonstrated the impact on premiums has been far below estimates offered by insurance industry lobbyists."