Pennsylvania Gov. Rendell Law Requiring Private Health Insurers To Cover Treatment For Autism

Main Category: Autism
Also Included In: Health Insurance / Medical Insurance
Article Date: 28 Jul 2008 - 1:00 PST

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A bill recently signed by Pennsylvania Gov. Ed Rendell (D) will require private health insurance companies in the state to provide diagnosis and treatment coverage of up to $36,000 per year for residents under age 21 with autism spectrum disorder, the Philadelphia Inquirer reports. The law, which is scheduled to take effect in July 2009, also requires insurers to provide coverage for applied behavioral analysis therapy that experts say is a key element in treatment of the disorder.

Patients needing treatments that exceed the $36,000 limit will be eligible for state Medicaid reimbursements to cover the extra expense. Health plans that provide coverage to businesses with fewer than 50 employees will be exempt from the new law. Currently, children with autism can enroll in the state's Medicaid program, which is managed by the Department of Public Welfare and spends about $185 million annually on medical-assistance programs for residents under age 21 with autism, the Inquirer reports. Under the new law, those children would be transferred from the Medicaid program into private health plans that could reduce state spending by about $13 million in the first year after it is implemented, according to the Inquirer.

Pennsylvania is now one of eight states to implement laws that require some level of insurance reimbursements for autism diagnosis and treatment, according to Autism Speaks. Nina Wall-Cote, director of the welfare department's Bureau of Autism Services, said, "There is definitely a move nationally to usher this type of legislation through," adding that "Pennsylvania is now on the cutting edge of that."

Supporters of the new law say that it was developed to avoid some of the problems faced by other states with similar laws. The Pennsylvania law clarifies the exact types of treatments that insurers must cover -- a problem that insurers and families in California continue to face and that has resulted in lawsuits, the Inquirer reports. Michael Piecuch, chief of staff to Pennsylvania House Speaker Dennis O'Brien (R), the law's main sponsor, said, "We have to start somewhere ... and this population has been categorically denied insurance coverage" (Couloumbis, Philadelphia Inquirer, 7/24).

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