Lawmakers briefed on insurance coverage for autism treatments

By LRC Public Information Office

FRANKFORT, Ky. (June 26, 2013) – Members of the state Interim Joint Committee on Banking and Insurance were updated Tuesday on implementation of legislation to expand health insurance coverage for autism treatments.

House Bill 159, passed during the 2010 Regular Session, increased claim amounts and expanded treatment options covered by insurance for patients with autism.

[pullquote_left]“We will improve this. …I want to get fixed whatever is not working correctly.” Committee co-chair Rep. Jeff Greer, D-Brandenburg.[/pullquote_left]

“The passage of House Bill 159 gave hope to many families who struggle with autism. The idea that these services would be reimbursed became a lifeline for families who have sacrificed so much for their children,” said Dr. Shelli Deskins, program director at the Highlands Center for Autism.

Deskins utilizes an intensive, scientifically-based autism treatment called applied behavioral analysis (ABA) therapy that was included in HB 159.  She told lawmakers that families have faced some challenges in taking advantage of the expanded benefits.

“Any time a new benefit is implemented in a state, there are going to be some difficulties as the coverage is rolled out throughout the insurance market,” said Lori Unumb, vice president for state government affairs for Autism Speaks.

Claims for ABA treatment have been denied for many reasons, including billing code issues and misunderstandings about the treatment, according to Unumb. Because there are no specific billing codes for ABA treatment, patients and providers can be confused about which codes to use for each insurance company, she said.

Some insurance companies did not recognize ABA as medically-necessary treatment prior to HB 159 and have required education about the therapy, Unumb said. Those types of issues should be resolved now, she said.

Melodie Shrader, executive director of Kentucky Association of Health Plans, told lawmakers that health insurance companies in the state continue to be committed to resolving the challenges of expanded autism treatment coverage.

Insurance companies are implementing appropriate training and identifying needed resources and networks, she said.

“We will improve this. …I want to get fixed whatever is not working correctly,” said committee co-chair Rep. Jeff Greer, D-Brandenburg.