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Ga. panel backs autism coverage requirement

Friday, Feb. 21, 2014 12:17 PM
Last updated 6:40 PM
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ATLANTA -- The state Senate Insurance and Labor Committee approved Thursday three bills related to health care, including one that mandates private insurance coverage for treatment of children with autism.

Committee Chairman Tim Golden, R-Valdosta, the lead sponsor on SB 397, said the costs of the treatment that would be covered under the legislation could not exceed $35,000 per year for each child. The eligible age for coverage would be capped at 6 years old.

In addition, employers could opt out of the coverage for “applied behavior analysis” if it led to a 1 percent annual increase in premiums. Companies with 10 or fewer employees would be exempt from the mandate. It also would not apply to larger employers that self-insure their benefits.

Legislative efforts to require insurers to cover applied behavioral therapy for autism have been ongoing in Georgia for five years, led by Sen. Tommie Williams, R-Lyons, whose niece’s daughter was successfully treated with the therapy.

Although expensive, applied behavioral therapy has been effective. Autism Speaks, a national autism science and advocacy organization, says nearly half of autistic children who receive early intervention with applied behavioral therapy will recover “typical function.”

The organization says the annual cost of the treatment ranges from $50,000 to $75,000 per patient.

Georgia is one of 16 states that does not mandate coverage for autism. The U.S. Centers for Disease Control and Prevention says autism affects one in 88 children. The disorder is characterized by difficulties with social interaction, verbal and nonverbal communication and repetitive behaviors.

Lt. Gov. Casey Cagle joined Williams and Golden on Thursday in making impassioned pleas for approval of the SB 397. The bill now goes to the Senate Rules Committee before heading to the Senate floor.

Also voting in favor of the legislation was Sen. Charlie Bethel, R-Dalton, who serves as Gov. Nathan Deal’s floor leader. Bethel was among committee members who noted that Deal supported funding for the autism therapy by allocating $2.4 million in his FY 2015 budget for coverage in the State Health Benefit Plan.

SB 397 would not mandate payment for applied behavioral therapy under Medicaid and PeachCare, the programs covering children of the state’s poorest families.

The Georgia Association of Health Plans, an industry trade group, opposes the effort to require autism coverage, saying it would unfairly increase costs for employers.

Golden noted that the state has another effort under way to reach more autistic children. In Georgia, one in 84 children suffers from the condition.

Golden said the state Department of Public Health is working with the CDC, the Marcus Autism Center and other organizations to create a pilot program that would reach out to children across Georgia for early diagnosis and intervention.

The Insurance and Labor Committee also approved two bills related to the Affordable Care Act, the federal law often called Obamacare.

SB 98 would ban coverage of abortion services in health insurance plans offered by the state and by the federal health insurance exchange, according to the bill’s sponsor, Sen. Judson Hill, R-Marietta. He said the goal is to prevent the use of state and federal taxes to pay for abortions.

Deal last year worked with DCH to eliminate coverage of abortion in the state employee health plan. SB 98 would codify the ban, Hill said.

Georgia, like a number of other states, has opted to let the federal government run its exchange under the ACA. Individuals who sign up for coverage are eligible for federal subsidies. SB 98 is aimed at preventing the application of those subsidies for coverage of abortion services.

The committee also approved SB 334, sponsored by Sen. Buddy Carter, R-Pooler. The legislation would prevent the state from establishing its own health care exchange and would prohibit any state employee from helping to implement the ACA.

SB 334 is a companion bill to HB 707, sponsored by Rep. Jason Spencer, R-Woodbine, which was approved by a House Judiciary subcommittee Wednesday.

Sen. Ed Harbison, D-Columbus, cast the lone vote opposing both SB 334 and SB 98.

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Little Lamb
Little Lamb 02/21/14 - 02:12 pm

This autism insurance coverage "mandate" looks pretty complicated. There are so many loopholes that citizens will be complaining even more than they are today with no mandates.

corgimom 02/21/14 - 04:56 pm
It is shameful that anybody

It is shameful that anybody would opt of this and allow a child, who could be treated and lead a successful life, do without necessary services.

No child ever picked autism, nor did their parents.

And I can personally testify that early intervention WORKS.

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