Mo. autism insurance mandate begins with new year

JEFFERSON CITY, Mo. -- Several thousand children will become eligible for insurance coverage of their autism therapies as a Missouri law takes effect Saturday. For thousands of others, their parents will continue to have to pay out of pocket or simply forgo the costly treatments.

Missouri's autism insurance mandate is among the most prominent new laws of the new year. It's intended to save money on health care for some Missouri families. Some of Missouri's other new laws are meant to save money for the state by merging police agencies and forcing new government employees to bear part of the cost of their pension plans.

Advocates for the autism insurance mandate had been stymied in the past because of concerns it could cause insurance premiums to rise. But they gradually gained momentum at the Capitol, culminating with the successful passage of legislation signed by Gov. Jay Nixon in 2010. The bill contained a 2011 start date to coincide with the renewal period for many insurance policies.

"It's vitally important to thousands of families and one of the most important things that I'll ever do," Nixon said.

Autism is a broad term used to describe a spectrum of neurological disorders that affect about 1 out of 110 children in the U.S., according to the federal Centers for Disease Control and Prevention. Children with autism often have problems with communication, behavior and social skills.

Missouri's new law requires insurers to cover $40,000 a year of "applied behavioral analysis" for children through age 18, and the cap could rise with inflation every three years. Many parents credit the intensive therapy with producing dramatic improvements in their autistic children.

But the insurance mandate covers only about one-fourth of Missouri's population -- mainly those receiving health insurance from small- to medium-sized employers. Large employers who insure themselves are federally regulated. And people with individual insurance policies will have an option -- not a requirement -- to buy autism coverage.

"Most of the phone calls that we get regarding this insurance are families trying to figure out whether or not they will be covered at all," said Sharon Moeller, the communications manager for Missouri Families for Effective Autism Treatment. "I think there's a great lack of understanding on who is actually being affected by this law."

The Missouri Department of Insurance, Financial Institutions and Professional Registration has posted an extensive question-and-answer section on its website for consumers curious about the new autism law.

Although some insurance companies warned of larger premium increases, an actuarial analysis by the consulting firm Oliver Wyman -- conducted for the advocacy group Autism Speaks -- estimated rates would rise less than 1 percent as the result of an autism insurance mandate.

Insurance rates generally have risen for the new year.

But "there are so many changes occurring with the federal health reform that it's hard to distinguish what the autism mandate might have done or might not have done, or whether there's any of the price increases that are attributable to the autism mandate," said Larry Case, the executive vice president of the Missouri Association of Insurance Agents.

The new federal health care law, which passed shortly before Missouri's autism law, gradually restricts the annual insurance caps that can be placed on essential health benefits, eliminating coverage caps entirely by 2014. But the U.S. Department of Health and Human Services said that does not affect Missouri's insurance cap on certain autism therapies, because they are not currently defined as essential health benefits.

Most Missouri laws take effect on Aug. 28 of the year in which the legislation passed. But like with the autism law, Missouri legislators delayed the start date until 2011 for the merger of the Missouri State Water Patrol into the Missouri State Highway Patrol. The wait was intended to allow time to join the two administrations before combining the water patrol's 94 officers with the highway patrol's work force of more than 1,000 people.

On Saturday, water patrol officers swap their brown uniforms for the blue ones of the highway patrol. Starting Jan. 10, they will undergo several weeks of training on motor vehicle laws, traffic crash investigations and policies. By April, their patrol boats will bear the emblem of the highway patrol.

"Our goal is for this to be a seamless transition as far as the general public goes," said patrol spokesman Lt. John Hotz.

Nixon has said the patrol merger could eventually save the state $3 million a year.

Pension changes that begin Saturday are projected to save $660 million over 10 years.

Employees that begin working for the state in 2011 will have to contribute 4 percent of their pay to their pension plan. The new charge will not apply to existing state workers, whose retirement system is funded through tax dollars and investment income. To qualify for their pensions, new employees also will be required to spend a decade working for the state instead of the current five years. And the minimum retirement age will be increased from 62 to 67 for most employees hired in 2011 or later.