OR HB 2918--"Insurance bill will help families dealing with autism"
June 29, 2007 by Regina Claypool-Frey
Eugene, Register Guard
Insurance bill will help families dealing with autism
Published: Friday, June 29, 2007
Parents of children with developmental disabilities have something to celebrate. House Bill 2918, which requires insurance companies to cover certain kinds of treatment for pervasive developmental disorders, awaits the governor's signa-ture.
The proposed new law was passed unanimously by the House on May 11. After making several amendments, the Senate passed the bill, and the House concurred with the amendments Tuesday.
State Rep. Chris Edwards, D-Eugene, a sponsor of the bill, expects the governor to sign the bill into law.
For years, parents have been frustrated to learn that treatments considered beneficial for people with autism - such as speech, physical and occupational therapy - were not covered by insurance. Under HB 2918, a health plan may not deny benefits for these rehabilitative services to children younger than 18 solely because that child has pervasive developmental disorder.
HB 2918 defines pervasive developmental disorders as neurological conditions including autism, Asperger's syndrome, developmental disability or mental retardation, and developmental delay. Currently, some insurance companies refuse to cover speech, physical and occupational therapy for PDD, even if the same child would be covered for identical treatment if he did not have autism.
For example, people who have trouble speaking after a stroke are routinely provided speech therapy by insurance companies. But many companies don't cover speech therapy for children with autism, even though both autism and stroke are neurological conditions creating problems with communication.
This restriction is short-sighted, because speech, occupational and physical therapy help people with PDD function better in the home, school, community and workplace.
"This bill says we must at least pay for treatments known to have a high positive outcome with reasonable predictability of improvement, such as speech therapy," says Edwards, who has a young son with autism.
Insurance companies still may limit the number of visits and the duration of treatment, and policyholders must still comply with the usual rules for deductibles and copayments.
The Senate has taken some of the teeth out of HB 2918, but even the amended version promises some measure of relief to families across the state.
"It's still a good bill, even though it's not as comprehensive as we'd like," Edwards says.
Unlike the original House bill, the Senate version applies only to children younger than 18. The original bill also required insurance companies to pay for treatment to help people with PDD maintain, as well as improve, their level of functioning.
Without continuous treatment, some people with PDD lose previously acquired skills. Opponents claim that paying for maintenance therapy is too expensive, although supporters say only a very modest increase in policy premiums would cover the cost.
Some opponents argued that insurers shouldn't have to provide coverage for autism because there is no known cause or cure. It's hard to understand that reasoning. If you have a condition that is usually covered by insurance, and it can reasonably be expected to improve with treatment, why does it matter what caused the condition? Why deny a child with PDD the tools to improve his speech, while providing the same services for a child with traumatic brain injury?
"Cause and cure are not the issues; treatment is the issue," Edwards says. "Insurance is the financial vehicle of choice for health conditions in our country, so it's appropriate that it (PDD) is covered."
No one in the Senate wanted to go on record as being against children with autism, Edwards says. Instead, opponents proposed amendments that weakened the bill until it became one they could vote for and still look supportive.
Although many insurance companies testified against the bill, a few have come out in support, Edwards says. "There is some division in the insurance community."
The bill also calls for the Health Resources Commission to review other available medical and behavioral health research on the treatment of PDD, and report to the next legislative assembly. Parents hope this will prompt a new bill mandating coverage for other well-researched treatments designed specifically for people with PDD, such as applied behavioral therapy.
This bill is long overdue. Children with autism learn and grow, given access to treatment. Many parents struggle to pay for treatment out of their own pockets, mortgaging their homes and liquidating their savings. Oregon families deserve better.
"This bill is a start," Edwards says. "But we still have a long road ahead of us."
Cynthia Whitfield (cynhome@msn .com) is a Eugene free-lance writer.