Missouri Senate OKs mandate for autism insurance

JEFFERSON CITY, Mo. -- Some health insurers would be required to cover up to $45,000 annually of intensive therapy for autistic children under legislation passed Thursday by the Missouri Senate.

Some parents of autistic children, who have lobbied for several years for an insurance mandate, expressed hope that lawmakers finally have hit upon a version that can reach the governor's desk by the May 14 end of the legislative session.

The Senate's 27-6 vote sends the bill back for final approval to the House, which passed a version with lower coverage caps earlier this year.

"I'm thrilled. This is a step that puts us at the goal line," said St. Louis attorney Bill Bolster, whose 13-year-old son has autism.

Bolster said insurance coverage of "$45,000 would mean the world to a lot of families and would also open up the world to a lot of kids." But the autism insurance mandate would not cover his family, nor the majority of Missourians.

The legislation applies primarily to people receiving health insurance from small- to medium-sized businesses whose group policies are regulated by the state. It would not apply to large employers who insure themselves and are federally regulated, such as the law firm where Bolster works.

Missourians with individual insurance policies would have an option -- but not a requirement -- to buy policies with autism coverage.

Autism is a broad term used to describe a spectrum of neurological disorders that affect about one out of 110 children in the U.S., according to the federal Centers for Disease Control and Prevention.

Starting Jan. 1, health plans affected by the Missouri legislation would have to cover the diagnosis and treatment of autism disorders. But coverage would be capped at $45,000 annually for children through 18 years old for "applied behavioral analysis," an intensive therapy that some parents say produces dramatic improvements in their autistic children.

The coverage threshold represents a middle ground between a $55,000 cap approved earlier by the Senate and a $36,000 cap passed previously by the House. The new version adds an annual inflationary adjustment to the coverage limit. It also keeps a House provision creating a state licensing process for behavior analysts and their assistants.

Like earlier versions, the legislation allows businesses with 50 or fewer employees to get an exemption from the autism insurance mandate if they can show it caused their premiums to rise by at least 2.5 percent over the previous year.

"We've done our best to try to reach a compromise with the House and insurance industry," said Sen. Scott Rupp, R-Wentzville.

Gov. Jay Nixon praised the Senate's passage of the bill. Rep. Dwight Scharnhorst, R-Manchester, who's sponsoring the measure in the House, said he expects the bill to pass in that chamber next week.

Although Rupp said the mandate should cause only a fraction of a percentage-point increase in insurance premiums, some lawmakers remain concerned about the cost to businesses.

Sen. Chuck Purgason, R-Caulfield, said the legislation amounts to another government mandate on businesses that already are struggling to afford health insurance for employees. He noted that small businesses can opt out of the mandate only after incurring a year's worth of higher costs.

"To me this is just another kick to small businesses," Purgason said.

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Autism bill is HB1311.

On the Net:

Legislature: http://www.moga.mo.gov