On Wednesday, Oklahoma may have finally gained enough momentum to push through barriers to autism reform. Legislation that requires health insurers to cover the treatment of children with autism received final legislative approval –– passing 65-26 –– in the House.
Note: An in-depth look at how Oklahoma, dragging its feet on autism reform, is struggling to play catch-up with the rest of the country –– or is it already game over?
On Wednesday, Oklahoma may have finally gained enough momentum to push through barriers to autism reform.
Legislation that requires health insurers to cover the treatment of children with autism received final legislative approval –– passing 65-26 –– in the House.
The bill has now been sent to Gov. Mary Fallin for her signature.
HB 2962 requires coverage for the screening, diagnosis and treatment of autism spectrum disorder in children younger than 9 years old. Under the measure, children would have access to applied behavior analysis for up to 25 hours a week, with a limit of $25,000 a year.
Coverage shall be provided for at least six years if the person isn't diagnosed or treated until after age three. The child would have to show sufficient progress and improvement determined by the health-care provider in order to receive the coverage.
Autism spectrum disorder affects how a person processes sensory information and their ability to interact and relate to others.
Oklahoma is one of only seven states in the nation that currently does not require insurers to cover autism, according to CenterForAutism.com.
Rep. Jason Nelson, R-Oklahoma City, and Sen. A.J. Griffin, R-Guthrie, proposed the bill.
Sen. Ron Sharp said he voted for the legislation.
“Having been a school teacher for 38 years, I recognize these autistic children are trainable and can be helped to become productive citizens,” Sharp said. “This legislation provides for that assistance.”
He said Oklahoma will either provide this assistance on the front end or may be forced to provide for these children on the back end as adults.
“Should there be a adverse effect on insurance premiums to provide this assistance, the legislation is voided,” Sharp added.
Tara Hood, of Guthrie, said the measure isn't breaking the bank, it's just asking insurance industry to do what it's supposed to do.
Hood has two children with autism.
She said some autistic children require intensive one-on-one therapy.
“But not all kids need that level of care,” Hood said.
“If we don't take care of these kids now, they will be so much more dependent later,” she said.
Currently, most states –– including the ones surrounding Oklahoma –– provide some kind of coverage, making a leap across the border a little easier to stomach.
Some have already chosen that route –– whether it's a family trying to afford care for an autistic child or a behavioral health care professional unable to make a living here.
Beverly Woodfin and her family moved to Texas in October 2014 –– choosing a state that had a mandate for autism care.
“When we left, initially, we were only going to stay away until Oklahoma insurance covered services,” she said. “We aren't planning to come back now. We have established ourselves where there are lots of services, great perks and great therapists.”
She said there aren't nearly enough therapists in Oklahoma.
“They can't make it there right now,” she said.
Deborah Renfroe, a Board Certified Behavioral Analyst (BCBA) –– who grew up and practiced in Oklahoma –– left last summer for Arizona. She said her whole family was uprooted so she could find adequate clientele.
“I was born and raised in Oklahoma –– owned a home and had friends –– our kids had friends there. We were hoping to stay there forever,” she said.
“Quite a few of us had to leave the state,” Renfroe said.
She said there is very low opportunity in Oklahoma.
“Without the insurance mandate, we can't bill insurance companies. The only company in Oklahoma we could bill was Tricare –– a military health care provider. Other than that, it leaves us with only people who can pay out of pocket.”
“I do hope to come back, but I can't until I can get paid as I do here,” she said. “Oklahoma offers about half of what I can earn in other states,” she said.
Renfroe said she guesses Oklahoma has some fear that it would drive up the cost of insurance.
“Other states have already proven that it doesn't. It would help the state,” she said. “Oklahoma needs this.”
The Centers for Disease Control and Prevention (CDC) estimate that an average of one in 68 children have an autism spectrum disorder (ASD).
More children than ever before are being classified as having autism spectrum disorders, according to the National Conference of State Legislatures (NCSL), at ncsl.org.
There is no cure for autism, but it is a treatable condition. Most health professionals agree that early intervention treatment programs are important, the website states. Treatment options may include behavioral and educational interventions, complementary and alternative medicine, dietary changes or medications to manage or relieve the symptoms of autism.
These treatments may be costly.
According to the CDC it costs an estimated $17,000 more per year to care for a child with ASD compared to a child without autism. Costs include health care, education, ASD-related therapy, family-coordinated services, and caregiver time. For a child with more severe ASD, costs increase to over $21,000 more per year.
A previous effort to gain insurance coverage for those
with autism –– dubbed Nick's Law –– failed in the 2009
Oklahoma legislative session.
As of December 1, 2015, 43 states and the District of Columbia have laws that require insurance coverage of autism services including Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, West Virginia, and Wisconsin.
Washington state is providing insurance coverage via a lawsuit and follow-up regulations.
Georgia, Hawaii, Mississippi, North Carolina, and South Dakota had previously had no legislative coverage and added coverage via legislation in their 2015 sessions. Other states may require limited coverage for autism under mental health coverage or other laws. At least thirty states mandate some form of autism services in their exchange.
Several states enacted legislation in 2015 addressing mandated autism coverage including: Colorado, Georgia, Kansas, Missouri, South Dakota, Virginia and Washington. Mandated coverage may be limited to specific age groups, number of annual visits or by an annual spending cap.
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