Advocates for autism treatment are making one last push this legislative session to require health care insurers to cover behavioral therapy.
Their hopes are on Senate Bill 493, which started life in the Senate as a regulatory bill about vehicle headlights and ended up after going through the House as a health and safety regulatory reform bill with a provision that requires insurers to cover the behavioral autism treatment up to $36,000 per year. The bill passed the House and has been waiting in the Senate for concurrence.
With budget negotiations taking center stage, it is unclear whether the issue will be addressed during this legislative session.
Nothing is likely to move through the Senate until the budget conference committee comes to a close, said Sam Blanton, a legislative assistant for Rep. Chuck McGrady, a Republican from Hendersonville who authored the autism provision.
The bill has been sitting in the Senates Ways and Means committee since June 30.
Its (the session) definitely in winding down mode, and were just making sure that autism stays in the forefront of their minds, said Lorri Unumb, vice president of state government affairs for Autism Speaks. Unumb and other Autism Speaks representatives were at the legislature last week talking to key legislators.
Unumb said that House Speaker Thom Tillis has been especially supportive of the initiative and that the bill could be being held for political capital.
Anytime the leadership of one chamber is out front in their support of a bill, that bill is subject to horse tradings, she said. But we feel good. We think theyre going to do the right thing for the families.
One family affected by autism was at the legislature with Unumb speaking to legislators. Tim Newman, the father of two 18-year-old sons with autism, said his sons greatly benefited from Applied Behavior Analysis when they were between the ages of 6 and 11.
Applied Behavior Analysis uses principles like positive enforcement, learning theories and interventions to make a positive change in the individuals social behavior. Emphasis is placed on increasing good behaviors and reducing any that could interfere with learning or even cause harm.
It helps them to be able to communicate They cant interact in social settings. It really helps them become mainstream members of society, Newman said.
Newman said that covering behavioral therapy would increase insurance premiums about 31 cents per month, compared to the thousands of dollars parents must pay for the treatment out of pocket. .
The treatment is currently not covered in many insurance policies and insurance companies are the main opponents of the bill. Blue Cross Blue Shield the largest insurance provider in the state has lobbied against the bill, saying behavioral therapy is educational rather than medical treatment.
Most health insurers already cover both diagnosis and treatment of autism. This includes doctor visits without limitations on number medications, physical therapy, occupational therapy and speech therapy, said Michelle Douglas, public relations manager for BCBS of North Carolina.
Douglas said that North Carolina already has 55 insurance mandates, which requires consumers to pay more for their health insurance and pay for coverage they dont necessarily need, and that behavorial therapy is a costly additional treatment.
Liz Feld, president of Autism Speaks, argued that the behavioral treatment is medical as it is prescribed by doctors and is an evidence-based treatment of autism.
Its not experimental, its not theoretical, Feld said. We dont wonder if its going to work.
More than 30 other states have been successful with passing similar legislation, Unumb said.
If it is not passed this session, it could be introduced in the next session, as it was this year. Autism advocates say they are committed to finishing the job.
Since we started working on this five years ago, in five years [children] could have had therapy starting at the age of 2. Now theyre 7 and they havent had this treatment, Feld said. This is what health insurance is for.