|
The Autism Society of Colorado is not actively pursuing any legislation in the 2011 session. Please sign up for our monthly newsletter (in the right hand menu on this page) to keep up to date on major events and legislative action items.
HIMAT (Health Insurance Mandated Autism Treatment (formerly known as Senate Bill 244 - 2009)
The Autism Society of Colorado is currently working collaboratively with providers and insurace companies to help insure that this law will be implemented properly. We will post new information as soon as we are able.
The Autism Society of Colorado Delivers Comprehensive Autism Insurance Reform
Denver, CO (June 3, 2009) -- Autism Society of Colorado, along with many advocacy groups joined Governor Bill Ritter Jr. for signing into law Senate Bill 09-244, which requires insurance companies to provide coverage of for treatment of autism.
According to Betty Lehman, Executive Director of the Autism Society of Colorado, “This is a significant advancement in Colorado health care legislation. Because of the unwavering support of State Senator Brandon Shaffer (D-17) and Representative Dianne Primavera (D-33), children with autism now have the insurance coverage for benefits they so desperately need and deserve which results in both quality of life and future savings in education and long term care.”
"Health care reform is a central part of the Colorado Promise and my strategy for leading Colorado forward," Gov. Ritter said. "Over the last 21⁄2 years, we've increased availability, improved quality and addressed costs. The bill I am signing today will help continue our efforts to build a strong, sustainable health care system for Colorado."
Colorado is the twelfth state to pass autism insurance reform joining Arizona, Florida, Illinois, Indiana, Louisiana, Montana, Nevada, New Mexico, Pennsylvania, South Carolina, and Texas that have passed similar autism insurance reform bills.
Quick Facts: SB 09-244
Concerning Health Insurance Benefits for the Treatment of Autism Spectrum Disorders
Law is effective July 1, 2010 - Directs health benefit plans to provide coverage for assessment, diagnosis and treatment of autism spectrum disorder and defines what type of coverage is required for the treatment of ASD, including Applied Behavior Analysis (ABA).
On or after July 1, 2010, annual maximum benefit for applied behavior analysis includes:
- Birth through 8 years of age = $34,000
- 9 years of age through 18 years of age = $12,000
- “Autism Spectrum Disorders" includes the following neurobiological disorders: autistic disorder, Asperger's disorder, and atypical autism as a diagnosis within pervasive developmental disorder not otherwise specified, as defined in the most recent edition of the diagnostic and statistical manual of mental disorders, at the time of the diagnosis.
- “Applied Behavior Analysis" means the use of behavior analytic methods and research findings to change socially important behaviors in meaningful ways.
- "Treatment Plan" means a plan developed for an individual by an autism services provider and prescribed by a licensed physician or a licensed psychologist, and developed in accordance with the patient-centered medical home.
- Defines who is a qualified provider, including, but is not limited to, speech, occupational, physical and specific qualifications for applied behavior analytic therapies.
- Specifies that treatments are not considered experimental or investigational and are considered appropriate, effective, or efficient for the treatment of autism.
Services include:
- evaluation and assessment services
- behavior training and behavior management and applied behavior analysis
- habilitative or rehabilitative care, including, but not limited to, occupational therapy, physical therapy, or speech therapy
- pharmacy care and medication
- psychiatric care
- psychological care, including family counseling
- therapeutic care
- Specifies that early intervention services are to be provided as specified in the IFSP, and such services shall not duplicate or replace treatment for autism spectrum disorders covered by private health insurance plans.
- Covered ASD services shall be considered the primary service to an eligible child, and early intervention services shall supplement, but not replace, covered ASD services.
- The benefits in subsection (1.4) shall be in addition to any benefits provided for in subsection(1.3) (i.e., early intervention services) and (1.7) (i.e., twenty visits OT, PT, ST).
- The coverage required is not subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the health benefit plan.
- The maximum benefits for the treatment of a health condition not diagnosed as an autism spectrum disorder, shall not be applied toward any maximum benefit amount established autism spectrum disorder.
- A carrier may not deny or refuse to provide otherwise covered services, refuse to issue, renew, or reissue, or otherwise restrict or terminate coverage under a health benefit plan because of a diagnosis of autism spectrum disorder or due utilization of services for which benefits are mandated.
- Does not apply to Individual Policies.
- Nothing in this section shall prohibit or prevent a person with an autism spectrum disorder from receiving mental health benefits in his or her health benefit plan.
- Legislative declaration specifies that due to the budgetary issues facing the state of Colorado during fiscal years 2008-09 and 2009-10, the general assembly cannot at this time fund an expansion of the children's basic health plan to include comparable provisions.
Other ways you can help.
- Click on the “Donate” button above and support our organization whose mission is to improve the quality of life for individuals with autism and their families
Do you need to find your legislator?
- Visit Project Vote Smart, www.vote-smart.org, enter your 9-digit zip code to find your legislators in the Colorado Senate and House.
|
