Legislature(2009 - 2010)CAPITOL 106
01/28/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB110 | |
| HB187 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 110 | TELECONFERENCED | |
| += | HB 187 | TELECONFERENCED | |
HB 187-INS. COVERAGE: AUTISM SPECTRUM DISORDER
3:58:18 PM
CO-CHAIR KELLER announced that the final order of business would
be HOUSE BILL NO. 187 "An Act requiring insurance coverage for
autism spectrum disorders, describing the method for
establishing a treatment plan for those disorders, and defining
the treatment required for those disorders; and providing for an
effective date."
3:59:16 PM
CO-CHAIR KELLER reflected on testimony that Applied Behavior
Analysis (ABA) was working well, and had resulted in a financial
savings. He commented that the fiscal impact on the insurance
companies needed to be scrutinized.
4:00:47 PM
CO-CHAIR KELLER re-opened public testimony.
4:01:13 PM
CO-CHAIR HERRON moved to adopt the proposed committee substitute
(CS) for HB 187, Version 26-LS0641\P, Bailey, 1/27/10, as the
working document.
4:01:31 PM
REPRESENTATIVE SEATON objected in order to hear the differences
from the original bill.
4:01:45 PM
REPRESENTATIVE PETE PETERSEN, Alaska State Legislature,
summarized the changes in Version P, which included a
clarification that "medically necessary" was applied to the
entire bill, the definition of "autism service provider" was
provided to be more specific, and the effective date and the
date for inflation adjustment were amended.
REPRESENTATIVE SEATON removed his objection.
[Version P was adopted as the working document.]
4:03:55 PM
REPRESENTATIVE SEATON asked if insurance coverage could be
limited to a specific amount for a particular disorder.
4:04:51 PM
REPRESENTATIVE PETERSEN, in response, said that he would refer
that question to Linda Hall.
4:05:14 PM
REPRESENTATIVE SEATON opined that an answer was necessary in
order to move forward with this plan.
4:06:08 PM
CO-CHAIR KELLER referenced the pie chart, "Health Coverage of
Alaska Population," [Included in the committee packets.] and
pointed out that HB 187 would only mandate coverage for private
insurance, which covered 23 percent of Alaskans, and included
48,000 children. He directed attention to an earlier testimony
from Mr. Jim Bouder, whose cost estimate was based on the
prevalence of autism spectrum disorder, and he noted a disparity
between these estimates and the projected cost in Alaska.
4:08:07 PM
REPRESENTATIVE PETERSEN replied that the cost depended on the
number of parents seeking treatment for their children. He
observed that rural Alaskans had limited easy access to medical
services. He shared that the Providence Alaska Medical Center
autism diagnostic network provided 20 hours of diagnosis for
each child patient and the network evaluated 6 children each
week. He informed the committee that this only resulted in a
two month backlog for the individual treatment plans, compared
to a six to eight month backlog in Seattle. He opined that this
backlog could diminish with passage of HB 187, as typically more
providers worked in an area where insurance coverage existed.
4:11:29 PM
CO-CHAIR KELLER asked about the projected cost of $3.60 per
member policy in Alaska. He recalled that Mr. Bouder had
estimated a premium cost of $2.24 when there was an autism
prevalence of 1:400, and $5.81 with a prevalence of 1:250. He
asked the sponsor about the projected prevalence of 1:100, and
how that reconciled with the projected premium cost of $3.60.
4:12:58 PM
REPRESENTATIVE PETERSEN referred to estimates from the Center
for Disease Control (CDC) that 1:100 children would be diagnosed
with some form of autism. He reported the $3.60 calculation to
be a mid-range estimate, which was supported by an actuary from
the Division of Insurance. He shared that the prevalence range
had been raised, so that it might be necessary to revise the
cost calculation. He opined that it would depend on the number
of families seeking treatment, and, in response to a question,
he said that few families sought treatment out of state. He
commented that those were often severe autism cases which
required a specialist not available in Alaska.
4:14:29 PM
CO-CHAIR KELLER declared that, although emotionally difficult,
it was a necessary responsibility to review the cost. He
pointed out that the cost projections were based on an existing
adequate provider network, and that this network did not exist
in Alaska. He asked the sponsor for a projection.
REPRESENTATIVE PETERSEN replied that he was encouraged by the
availability of treatment in Alaska. He referenced the
Governor's Council on Disabilities & Special Education, which
reported that 15 autism specialists were currently enrolled in a
two year program. He explained that, after 1500 hours of
supervised field work, they would be board certified [associate]
behavior analysts. He reported that Alaska was projected to
need 30 analysts. He observed that there were also six graduate
students working on the field work for the certification, and
that more would enter the field as the demand increased.
4:17:55 PM
REPRESENTATIVE CISSNA asked for an estimate to the increase in
autism, and she opined that parents not trained in recognizing
behaviors could miss the early, initial opportunity for
treatment. She offered support for HB 187, as it could lead to
a healthier workforce. She suggested that family and friends
could help with the treatment to offset some of the cost.
4:20:53 PM
REPRESENTATIVE T. WILSON asked if any private [insurance]
companies offered autism coverage, and why the state insurance
plan did not offer autism coverage.
4:21:17 PM
REPRESENTATIVE PETERSEN opined that the governor was aware of
this legislation. He offered his belief that it was not unusual
for the state to adopt a "wait and see" approach, and, as the
effective date for the bill would be January 1, 2011, the state
would be able to "sign on."
4:22:19 PM
REPRESENTATIVE SEATON pointed to the definition for "medically
necessary," Section 1, Subsection (e)(5) of Version P. He
explained that for workforce injuries, any treatment performed
was defined as "medically necessary;" whereas HB 187 identified
that anything could be medically necessary. He asked if there
was a broad spectrum of services that would be defined as
"medically necessary" under subparagraphs (A)-(C). He expressed
concern that a lack of treatment restrictions could add to the
cost.
4:23:45 PM
REPRESENTATIVE PETERSEN relayed that Providence Alaska Medical
Center reached a diagnosis, identified the child's placement on
the spectrum, and developed an individual treatment plan. He
said that HB 187 would limit the insurance company annual
liability to $36,000.
4:24:50 PM
REPRESENTATIVE SEATON pointed out that the wording of the bill
would make it a statutory requirement that the plan "must
identify all the medically necessary pharmacy care, psychiatric
care, psychological care, rehabilitative care, and therapeutic
care required." [Version P, Section 1, page 1, lines 13-14 and
page 2, line 1.] He expressed that this might be a much broader
list than a sequential plan, and that there might be some
unintended consequences.
4:25:55 PM
CO-CHAIR KELLER referenced a prior testimony which stated there
were no biological markers for autism, and he opined that,
therefore, a general practitioner could not make a diagnosis.
He asked if any other statutes defined "medical necessity" and
he also expressed concern for any unintended consequences.
4:26:38 PM
REPRESENTATIVE PETERSEN listed the autism diagnostic
contributors at Providence Alaska Medical Center to include an
occupational therapist, speech therapist, developmental
pediatrician, nurse practitioner, and social worker.
4:27:24 PM
GWENDOLYN LEE expressed her support for HB 187 as early
intervention would now be eligible for insurance payment. She
established the critical necessity for early diagnosis, which
often resulted in an enhanced quality of life and functioning
skill level. She directed attention to the payment cap as a
protection for the insurance companies.
4:30:23 PM
KATHLEEN FITZGERALD, Chair, Developmental Disabilities (DD)
Committee, Autism Ad Hoc Committee, Governor's Council on
Disabilities & Special Education, reported that neuro-
psychiatric developmental clinics were now in Barrow, Kotzebue,
Nome, Bethel, Dillingham, Kodiak, Fairbanks, Juneau, Ketchikan,
and Anchorage. She certified that this had lead to a much
better job of screening and diagnosing. She shared that a
developmental diagnosis for autism needed a multi disciplinary
team, as it was neuro developmental without medical markers.
She reported that diagnosis and treatment for a broader
spectrum, instead of just for severe autism, had increased the
statistic for reported autism. She specified that not all
children would need the most intensive services, with fewer
using the full range of treatments. She relayed that the group
had received a federal grant which focused on autism
identification and diagnosis in rural communities, to allow for
quicker, appropriate intervention.
4:35:24 PM
MS. FITZGERALD explained that it was now possible to identify
experts to tie in with the Alaska system. She opined that
within two years, there would be good in-state options for
families. She offered her belief that insurance needed to be an
integral means of payment for the services. She mentioned the
possibility of obtaining an early intervention waiver. She
emphasized that a lot of time and thought had been given to
developing a thorough system that brought appropriate service to
Alaska.
4:38:04 PM
TANJA UPDIKE, Governor's Council on Disabilities & Special
Education, declared that she was a member of the council, but
more important, she was a mother with a child with autism. She
shared some poignant moments of his early childhood and the
obstacles posed for her family. She relayed that she faced on-
going resistance to payments from the insurance carrier. She
touted the importance of early diagnosis and treatment. She
expressed her strong support of HB 187.
4:42:20 PM
MS. FITZGERALD reiterated the cost savings, and the need for
special education and early intervention. She offered a
recommendation for a change to the wording of the bill. She
pointed to the original bill, page 3, line 28, and suggested to
add the word "administered," after "delivered," as this would
also cover the responsibility for out of state insurance
companies working in Alaska.
4:43:59 PM
REPRESENTATIVE SEATON requested that Ms. Fitzgerald reference
her suggestion to Version P.
4:44:17 PM
MILLIE RYAN, Executive Director, Governor's Council on
Disabilities & Special Education, offered to answer any
questions.
4:44:53 PM
CO-CHAIR KELLER asked what was the best way to offer coverage
for autism.
4:46:15 PM
MS. RYAN replied that a responsibility of insurance companies
was to cover health costs. She stated that autism should have
the necessary coverage for health care services. She allowed
that the family and the state of Alaska could also pay, but that
one entity should not bear the entire cost.
4:47:19 PM
CO-CHAIR KELLER said that insurance companies sold a commodity,
and he opined that it was difficult to get insurance companies
to serve Alaska. He questioned how many mandates the insurance
companies in Alaska would accept and continue to offer coverage.
MS RYAN reported that the actuarials indicated the cost would be
$3.60 per insurance premium, but she granted that an unlimited
number of coverages would not be feasible.
4:48:55 PM
REPRESENTATIVE T. WILSON asked Ms. Updike about her insurance
coverage.
MS. UPDIKE replied that her insurance did not pay, but that
TEFRA [Tax Equity and Fiscal Responsibility Act] and the state
of Alaska offered some coverage. She explained that her son
received minimal therapies, and that many were administered at
home. She reported that without the guidance of a good care
provider, many families would not be aware of TEFRA. She
reported that her insurance company told her that autism was "a
delay or it's something he will grow out of, so he doesn't need
services."
4:50:05 PM
REPRESENTATIVE T. WILSON asked about the annual out of pocket
expense.
JENNIFER CARD, Licensed Clinical Social Worker, disclosed that
she was a licensed clinical social worker and the mother of a
child with autism. She reported that when she moved to Alaska
six years ago, she experienced difficulties in finding services
for her son, so she pursued a Masters degree in social work and
certification in Applied Behavior Analysis in order to offer
better care for her son. She related that it was necessary to
hire support staff to maintain a home care program, and this was
not covered by TEFRA. She shared that the cost for a care
provider was $15/hr for 30 hours a week. She expressed the
difficulty for families who did not have that money.
4:52:35 PM
REPRESENTATIVE CISSNA expressed concern with "not having in
state services for our children." She asked for clarification
to the number of autistic Alaskan children being treated out of
state. She questioned the cost of not having in state care.
4:53:42 PM
MS. RYAN, in response to Representative Cissna, said that 118
children with the most severe issues were still out of state,
and of these, she estimated that 25 children had autism. She
opined that some of these kids might qualify for a mental
retardation developmental disability waiver. She explained that
it would be best to serve them in Alaska, which was a tenet of
the Bring the Kids Home program. She offered her belief that a
more specialized provider would be necessary in Alaska.
4:55:47 PM
REPRESENTATIVE CISSNA commented on the difficulty of keeping
resources in Alaska. She directed attention to the cost to
society of having a child not get service in Alaska.
4:56:38 PM
MS. RYAN referenced a study done by Harvard economist Michael
Ganz, and she stated that "it cost about $3.2 million per capita
to not provide services at the time when it is most needed which
is as soon as the child is diagnosed."
4:57:25 PM
LORRI UNUMB, Attorney and Senior Policy Advisor, Autism Speaks,
Former Law Professor, George Washington University Law School,
said that she became a full time advocate for kids with autism
when she became aware of the inequity in the insurance arena.
She presented a PowerPoint. Referring to slide 2, she noted
that the term autism was often misused to refer to either autism
spectrum disorder or one of the disorders. She pointed to slide
3, and explained the umbrella category, pervasive developmental
disorders, which included: autism spectrum disorder. She noted
the three disorders included in autism spectrum disorder:
autistic disorder, asperberger syndrome, and pervasive
developmental disorder not otherwise specified (PDDNOS), which
was a milder form of autism.
MS. UNUMB noted that there was treatment for autism, but not a
known cure. She shared that Applied Behavior Analysis (ABA)
therapy resulted in a physiological change, detectable in a
brain scan. She reported that although ABA therapy was the most
commonly prescribed protocol, it was a denied coverage, labeled
by insurance companies as experimental. She pointed to major
insurance company policies which explicitly excluded ABA
therapy. She observed that the Surgeon General, National
Research Council, and American Academy of Pediatrics all stated
that ABA therapy was not experimental or investigational. She
shared studies of ABA therapy which indicated that 47 percent of
the kids overcame the disabling condition "to the extent they
can go to first grade indistinguishable from their peer." She
noted that the remaining 53 percent also made significant
clinical gains.
5:02:08 PM
MS. UNUMB disclosed that, as ABA therapy was intensive, it was
also expensive, and that the treatment for her son cost $75,000
per year, out of their pockets. She revealed that these
extraordinary medical expenses had resulted in three [tax]
audits [by the Internal Revenue Service (IRS)]. She noted that
children from families that could not afford this treatment were
not treated, and she lamented that a working treatment was only
available to the wealthy. She opined that this was not fair,
especially to families who had insurance.
5:03:51 PM
MS. UNUMB referred to the Harvard study mentioned earlier, which
projected the direct and indirect, [loss of productivity]
lifetime costs of $3.2 million. She pointed to a 1998
Pennsylvania study which showed a direct taxpayer cost of $1
million for each un-treated child with autism. She pointed to a
slide which charted an increase to the prevalence rate. She
opined that this would cost the state of Alaska a huge amount if
the services were not made available. She identified 14 states
which had enacted insurance reform.
5:06:48 PM
MS. UNUMB explained that, in 2005, she wrote the South Carolina
autism legislation and she had seen it successfully implemented.
She pointed out that providers had joined networks and
negotiated satisfactory reimbursement rates, and she shared that
the number of certified behavior analysts had since doubled.
She welcomed that no insurers had left South Carolina, and the
premium increase had been miniscule. She affirmed that a
similar bill was pending in 19 more states.
5:09:08 PM
MS. UNUMB referenced an annual report by the Council for
Affordable Health Insurance titled "Health Insurance Mandates in
the States" which listed all the insurance mandates in each
state with its estimated impact on premiums. She directed
attention to the impact from autism premiums, which was less
than 1 percent. She shared that Autism Speaks had a contract
with an independent actuarial firm to produce studies on pending
bills, and she offered for an independent actuarial on HB 187.
She pointed out that every state actuarial study had shown an
impact of less than 1 percent. She detailed that the impact to
Minnesota premiums was 83 cents per month, and the average cost
per patient for ABA therapy was $30,000. She reminded the
committee that Minnesota had an unlimited cap on autism therapy.
5:10:58 PM
MS. UNUMB noted that South Carolina had included the state
employee health plan within the mandate at an estimated annual
cost of between $9 and $18.9 million. She observed that the
actual cost was $856,371, which was a member premium cost
increase of 20 cents per month.
5:12:34 PM
REPRESENTATIVE SEATON asked for a copy of the PowerPoint.
5:13:39 PM
JAMES BOUDER, COO, The Vista School and The Vista Foundation,
submitted his cost benefit analysis and explained that the
Pennsylvania cost for its mandate, which was similar to HB 187,
was less than 1 percent. He pointed out that by applying this
same methodology, Alaska could expect an impact of less than 1
percent on premiums. He agreed that once a funding stream was
accessible, providers would become more available. He said a
gradual cost increase would be spread over the first five to six
years. He discounted the idea that this would dramatically
impact premiums.
5:17:17 PM
MR. BOUDER testified that actuarial firms had all agreed with
his findings of a minimal cost impact. He estimated that this
would cost Alaskan rate payers about $3.60 month. He confirmed
that the mandate was not a significant cost, but emphasized that
as an investment, extending these services would result in a
savings of $667 million over the lifetime of children with
autism in Alaska. He opined that this was a low upfront cost
with a significant return on investment over time. He
reiterated the importance of avoiding the human service costs,
and noted that people with autism will get jobs and become
taxpayers.
5:20:56 PM
REPRESENTATIVE SEATON referring to Version P, page 1, lines 9 -
13, asked if this would exclude care normally provided by a
waiver. He also asked if Version P would require that the only
care providers would be those listed in Section 1, subsection
(e), paragraph (1)(A)-(E). He opined that this was not what he
believed to be the intent.
[HB 187 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| 187sup.PDF |
HHSS 1/28/2010 3:00:00 PM |
|
| hb110pkt.PDF |
HHSS 1/28/2010 3:00:00 PM |
HB 110 |