A change to the state’s new autism coverage insurance mandate moved Wednesday to the Senate, despite evidence of a lack of communication between legislators and the Kansas Insurance Department.
Alterations were expected after legislators, autism advocates and insurance companies came together on a bill in the 2014 session to mandate that health insurance plans for businesses with more than 50 employees include limited coverage of childhood autism treatments.
But legislators waited until almost the end of the 2015 session to address a change in the definition of those “large-group” plans that will be imposed by the federal Affordable Care Act.
Starting Jan. 1, 2016, the ACA will change the threshold for a large-group plan from 50 employees to 100.
That could trigger a host of changes to employer plans within that window. But one that concerns Kansas lawmakers is that the state would have to subsidize the autism coverage for some plans because the coverage mandate was enacted after the ACA.
To avoid that, the Senate Financial Institutions and Insurance Committee called a special hearing on Senate Bill 303 and amendments to that bill.
Clark Shultz, the insurance department’s legislative liaison, presented the committee with an amendment that would have tied the autism bill’s definition of a large-group plan to the new ACA definition.
“We are trying to conform federal law with state law,” said Shultz, who until last year was a senator himself. “You don’t have to do anything. If you don’t do anything, however, what will happen is the state will have a liability to pay for part of that coverage.”
Sen. Jim Denning, a Republican from Overland Park, seemed surprised to see the insurance department’s amendment. He said he had his own version of a fix that he had been working on with the department and other stakeholders, including the advocacy group Autism Speaks, Blue Cross and Blue Shield of Kansas City and Rep. John Rubin, the Shawnee Republican who spearheaded last year’s autism coverage bill.
“This amendment was the one I thought we worked on all day yesterday with the insurance department and Autism Speaks,” Denning said. “So this is the amendment I got sign-off on from Autism Speaks.”
With new Kansas Insurance Commissioner Ken Selzer looking on, Sen. Vicki Schmidt, a Republican from Topeka, grilled Shultz about the surprise amendment.
“Why in the world didn’t you circle back to Sen. Denning, who’s apparently been the lead dog on this?” Schmidt said. “Why wouldn’t you circle back to him and present that to him before 9:30 this morning?”
Shultz said Denning had worked hard on his amendment, but the department thought its version was simpler and had made known to all parties throughout the negotiations its preference for the simplest change possible.
“If you want to ignore our amendment, you certainly can,” Shultz said. “It is not something we just put together.”
Schmidt also asked why the committee had waited until the tail end of the 2015 session to start addressing the issue.
Denning took the blame for that.
In the end, the committee approved Denning’s amendment, combined with a technical change from the insurance department to clarify that it goes into effect the same day as the new ACA rules.
Sen. Jeff Longbine, an Emporia Republican who chairs the insurance committee, said Senate leadership has told him the full Senate will address the bill before the end of the session.
The committee’s two Democrats — Topeka Sen. Laura Kelly and Manhattan Sen. Tom Hawk — requested information on the number of children with autism who would retain coverage from plans in the 51- to 100-employee window if the change was not made and the state agreed to subsidize the coverage.
Hawk said after the meeting he doubted it was a large number, given that the current large-group mandate covers only about 750 of the estimated 4,000 Kansas children with autism who could benefit from the applied behavior therapy coverage.