Legislature still wrestling with bills dealing with health insurance and autism

Push to expand coverage resisted by insurance companies

1 | Children, Legislature, Insurance

Cheryl Richt and her 14-year-old autistic son Christopher wait to see a doctor on a recent visit to Topeka. The Manhattan woman says if autism coverage were not included in her family's health insurance plan, it would cost her family about $8,000 a month to get her son the behavior therapies that have made it possible for him to live at home.

Cheryl Richt and her 14-year-old autistic son Christopher wait to see a doctor on a recent visit to Topeka. The Manhattan woman says if autism coverage were not included in her family's health insurance plan, it would cost her family about $8,000 a month to get her son the behavior therapies that have made it possible for him to live at home.

— Unlike here in Kansas, Missouri requires its state-regulated health insurance plans to offer coverage of autism diagnosis and treatment for children.

That’s why most of the youngsters enrolled at the Kansas City Autism Training Center in Prairie Village, actually live on the Missouri side of the state line, which is about four miles east of here as the crow flies.

“It’s pretty simple, really,” said Ron Johnson, who runs the training center. “In Missouri, insurance covers autism, so families go where the services are. It doesn’t matter that they’re across the line in Kansas.

“Most of the families we see from Kansas are private pay,” he said. “We used to see people taking out second mortgages, or going through their 401(K)s, or borrowing money from friends or family. But for us, that’s kind of gone away because we’re full and because they can just move to Missouri (to get insurance coverage).

“But if you’re not able to do that and if you’re not from a fairly wealthy family, then, chances are you’re desperate,” Johnson said. “.”

No ‘appreciable impact’

Missouri has mandated the coverage for three years. The state insurance department last month issued its annual report on the costs associated with autism coverage and its effect on the state's insurance market.

According to the report, the numbers of autistic children, ages 0 through 18, who received treatment increased 22 percent last year, from 2,508 in 2012 to 3,070 in 2013. Spending increased almost 27 percent, from $6.5 million in 2012 to $8.2 million in 2013.

Despite the increases, the report cautioned lawmakers against assuming the mandate had created an undue burden on the state’s insurance market.

“While costs associated with autism-related treatment have risen over the prior two years, the fact that these costs represent just two-tenths of one percent of overall claim costs makes it very unlikely that they will have any appreciable impact on insurance premiums,” the report concluded.

The state's insurers paid out more than $4 billion in total claims last year.

Johnson said he doesn’t understand why Kansas policymakers won’t follow Missouri’s lead on the issue. Missouri is among the 32 states that require their state-regulated health insurance plans to cover treatment and diagnosis of autistic children.

“I’m sitting here in Johnson County, seeing all these families that are doing everything they can to save their kids, and then I see on the news that (legislators) are talking about how hard somebody can spank your kids and whether someone can decide not to serve food to gay people,” he said. “It’s just mind boggling.”

The guinea pig

Since 2011, the Kansas State Employee Health Plan, which covers about 100,000 state and local government workers, their families, and retirees, has been required by state law to cover autism treatments for children. It was implemented as a test of what it might cost to require all state-regulated Kansas plans to offer it.

According to the plan's administrators, 129 children are getting services through it; 70 of which are age 10 or younger. According to a plan official, the coverage has added about 29 cents per month per member to the plan’s premium costs.

The health plan officials say they are satisfied with the results.

“The Kansas Health Care Commission is pleased with the level of service that it provides to families with autistic children, and I don’t anticipate that it will be making changes to what it provides,” said Jim Clark, secretary of the Kansas Department of Administration and chair of the five-member panel that oversees the plan.

Competing proposals

There are two bills before the Kansas Legislature that would alter the coverage rules for autism in the state, though neither would go as far as Missouri.

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Rep. John Rubin, R-Shawnee.

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Rep. John Rubin was pushing House Bill 2531 with the support of parents of autistic children.

It would allow an estimated 750 children across the state to get coverage, including up to 40 hours per week each for behavior therapies.

“This is the right thing to do,” said Rubin, a Shawnee Republican. “If we can help these kids and their families, we should.”

The other proposal, HB 2704, was supported by the insurance industry. It would limit the coverage to children ages 10 and under and allow them up to 10 hours per week of therapy. It would extend coverage to about 170 children.

The bill was introduced in response to Rubin’s bill, which insurance companies opposed, saying it would drive up health care costs and increase premiums.

“The insurance industry believes that these limits are appropriate in order to provide medically necessary services to Kansas children who need them while also protecting all Kansans from higher premiums and taxes,” Mary Beth Chambers of Blue Cross Blue Shield of Kansas wrote in an email to KHI News Service.

The industry has historically fought mandates to cover treatments not considered medically necessary.

Autism, they say, is a cognitive disorder – not unlike dyslexia - rather than a medical condition.

”The debate about what is a medical service versus what is cognitive therapy has not been fully resolved and remains at the heart of this matter,” Chambers wrote. “Traditionally, health insurance companies do not pay for cognitive therapy for any of their members.”

If they did, she said, it would “significantly increase premiums for all insured people.”

A compromise

Now, according to Rubin, there is a compromise that would meld the two proposals:

It would require large group plans to offer autism coverage starting Jan. 1, 2015. Individual and small-group plans in place prior to the 2011 enactment of the Affordable Care Act would be added to the mandate beginning Jan. 1, 2016.

The coverage currently offered in the state employees' plan would remain unchanged. But therapy treatment would be limited to 10 hours per week in the plans newly adding the coverage.

House Insurance Committee Chairman Scott Schwab, an Olathe Republican, has agreed to hold a hearing on the compromise measure March 10. And House Speaker Ray Merrick, a Stillwell Republican, has said he wants some sort of autism bill passed this session

Coverage that makes a difference

“The people who run the insurance companies may not think autism is a medical condition,” said Cheryl Richt of Manhattan, the mother of a 14-year-old autistic son. “But there’s a whole team of doctors at the Mayo Clinic that says it is.”

Richt, a music professor at Kansas State University, said her son is covered by the State Employees Health Plan and has shown improvement as a result of the therapies he began receiving at age 11 after lawmakers added the coverage mandate to the state health plan.

“We’ve just gotten to the point where he can put cereal in a bowl,” Richt said. “He can’t quite feed himself like the other kids his age can, but we’re getting there. He’s making progress.”

Before that, caring for the boy was so difficult that he was sent to Lake Mary Center, a school in Miami County for children with severe disabilities.

“He was completely out of control,” Richt said. “We had no one to help us. The school had three people with him, they had him restrained, they had him in a locked room. It was awful. They were as overwhelmed as we were.”

Christopher, her son, spent two years at Lake Mary Center. For most of the second year, he received 50 hours a week of intense, one-on-one behavior therapy.

“Lake Mary saved my family,” Richt said. “Christopher was able to come home.”

Richt and her husband, also a K-State professor, have two other children. She said without the autism insurance coverage, it would cost the family about $8,000 a month to continue the treatments that have allowed him to stay at home.

None of the proposals before the Legislature would affect the large-group, self-insured plans in Kansas with respect to autism coverage. Several already provide it.

Among the company plans that include autism coverage are those operated by Cerner, Garmin, Koch Industries and Children’s Mercy Hospital.

Tricare, the U.S. military’s health insurance plan, also covers autism.



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Comments

JoanKelley (Joan Kelley)March 3, 2014 at 5:19 p.m.

Thank you for this heartbreaking yet familiar story.
Unless one has actually cared for a profoundly autistic loved one 24-7, it is impossible to imagine how parents actually remain stable while doing so. Retaining trained support staff, keeping the child, peers and staff safe, lack of sleep, impact on family members are just a few challenges we face.
When we have done all, we ask that our legislators help us find ways to keep our loved ones HOME, if possible, and SAFE, using whatever means necessary, by funding proactive and proven systems. Legislators may come and go, but we are committed to the life-long care of our loved ones, willing to do whatever it takes. Yet as Ms Richt shares, loving parents are often in desperate need of help - help that involves a continuum of care, after having exhausted all strength, resolve and personal resources to do so.