Legislature(2011 - 2012)CAPITOL 106
04/10/2012 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB74 | |
| SB98 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 74 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 98 | TELECONFERENCED | |
SB 74-INS. COVERAGE: AUTISM SPECTRUM DISORDER
3:02:49 PM
CHAIR KELLER announced that the first order of business would be
SENATE BILL NO. 74, "An Act requiring insurance coverage for
autism spectrum disorders, describing the method for
establishing a covered treatment plan for those disorders, and
defining the covered treatment for those disorders; and
providing for an effective date."
SENATOR JOHNNY ELLIS, Alaska State Legislature, stated that
proposed SB 74 required "insurance coverage of medically
necessary, evidence based treatments of autism spectrum
disorders (ASD) for individuals under the age of 21, as
prescribed by a licensed physician or psychologist." He
clarified that these were not experimental treatments, but were
medically necessary treatments which included speech, language,
physical, and occupational therapies and behavioral
interventions recognized by the U.S. Surgeon General, the
National Institute of Child Health, and the American Academy of
Pediatrics as effective forms of medical treatment. He declared
that autism was treatable, and that the efficacy of behavioral
interventions for the treatment of ASDs was well established.
He stated that intensive behavioral therapy had been shown to
increase IQ, language skills, academic performance, and
sociality, and reduce long term medical costs. He reported that
nearly half of those receiving medically necessary early
intervention and treatment did not require lifelong services and
support, while half of these children were able to achieve
normal functioning after two to three years of treatment. He
pointed out that an increase to functionality would
significantly reduce the fiscal impact on the State of Alaska.
He noted that the Governor's Council on Disabilities and Special
Education were strong supporters of the proposed bill, and had
reported that autism insurance coverage would save $208,500 per
child in avoided special education costs, with a lifetime
savings of just over $1 million per child. He declared that,
without treatment, an autistic individual would cost the state
about $3.2 million, which included lost productivity and adult
care.
3:07:09 PM
SENATOR ELLIS declared that the proposed bill would only
slightly increase insurance premiums. He shared that the cost
would be about 0.39 percent of insured premiums, or about $1.34
per month for each policy holder. He noted five other states
which were good indicators of the actual cost, as claims data
for two years of implementation of this demonstrated that
premiums were lower than predicted, with an average cost to each
member of 31 cents per month at the end of the second year. He
pointed to other insurance mandates that had passed with
bipartisan support, which included prostate cancer screening and
well-baby examinations. He declared that the proposed bill
would help children, save marriages, and keep families together.
3:10:04 PM
REPRESENTATIVE DAN SADDLER, Alaska State Legislature, shared the
personal story of his autistic son, who was finally diagnosed
when he was six and one half years of age. After researching
autism, he and his wife had agreed that applied behavioral
analysis (ABA) was the only evidence based, scientifically
founded treatment for autism. He listed the therapies and
consultations outside Alaska, as there were few providers in the
state. He shared that they had borrowed from family, refinanced
their house, used their insurance to its maximum extent, and
spent "many scores of thousands of dollars out of pocket." He
said that an attempt at enrolling his son in the public schools
in Anchorage had not been successful, as his son did not receive
the necessary intense applied behavioral analysis services. He
shared that his son and his wife had moved to Connecticut for
almost two years of high quality, intense ABA services, but were
now back in Eagle River, where his son was enrolled at an ABA
school. He declared that his family's experience illustrated
the benefits of ABA, as his son was now able to talk, read, "do
math as well as a Saddler can," and receive benefit from school.
He shared that, although his family had not broken apart, there
were scars, which was a common experience for families with
special needs children. He declared that the proposed bill
would help eliminate the huge upheavals in life by providing
good service for children at a young age. This would improve
their prospects for a meaningful life with the maximum progress
in life, save the State of Alaska a lot of money from social
services and care, and keep families together. He pointed out
that the increased cost of premiums would be covered by the
reductions in educational and medical expenses. He noted that
insurance pools the risks and shares the costs of illnesses. He
declared his support of the proposed bill, and although it may
not be the best solution, it was a solution that was available
today. He summarized that "every year there is no action, more
children slip into darkness."
3:14:17 PM
CHAIR KELLER commented that, although the upcoming testimonies
would reveal challenges and problems with the proposed
legislation, it was not insensitive to the issue.
REPRESENTATIVE HERRON expressed his agreement to the sensitivity
of the issue, and asked if Representative Saddler was aware of
the autism coverage incentive program being offered in Michigan.
REPRESENTATIVE SADDLER expressed his desire for more
information.
REPRESENTATIVE HERRON, pointing out that the proposed bill was a
health issue and an insurance issue, asked about forwarding it
to the House Labor and Commerce Standing Committee.
REPRESENTATIVE SADDLER stated that the House Health and Social
Services Standing Committee was a good committee to discuss the
issues and concerns, and that the House Labor and Commerce
Standing Committee would be an appropriate committee to discuss
the fiscal ramifications of the proposed bill.
3:17:00 PM
LORRI UNUMB, Vice President, State Government Affairs, Autism
Speaks, shared that she had an eleven year old son with autism,
and that she had formerly worked as an attorney with the U.S.
Department of Justice, and a Professor of Law at George
Washington University. She declared that she decided to
advocate full time on behalf of individuals with autism when she
recognized the "inequity in the insurance arena." She noted
that she had written an academic textbook, "Autism and the Law,"
and that she also taught a law school course on the subject.
She clarified that autism was a medical condition, with
diagnosis and treatment by a medical doctor. It cannot be
cured, but it can be treated. She reported that more than 50
percent of the time, treatment allowed that children could enter
the first grade indistinguishable from their peers, which
resulted in huge savings in special educational costs.
MS. UNUMB directed attention to slide 3, "ABA Therapy Is Not
Experimental," and stated that the most commonly prescribed
treatment was applied behavior analysis (ABA) therapy which,
although it had been used for decades in treatment, was often
deemed an experimental treatment by insurance companies.
3:18:57 PM
MS. UNUMB moved on to slide 7, "Autism Prevalence on the Rise,"
which depicted the exponential increase to the rate of autism
over 35 years. She declared that statistics showed that 1 in 88
children were diagnosed with autism. She emphasized that,
unless treatments were initiated immediately, the State of
Alaska would be hit "with a huge autism tsunami in terms of
special educational costs." She pointed out that the cost would
also include group homes, or institutionalization, with an
average per person cost of $3 million for children who did not
receive treatment. She declared that, without private health
insurance coverage, there would not be the treatment.
3:20:16 PM
MS. UNUMB identified that slide 10, "States with Autism
Insurance Reform," listed the 29 states with meaningful autism
insurance legislation. She mentioned that Michigan had just
passed an autism insurance bill. She reported that both liberal
and conservative states had already passed legislation. She
mentioned that opponents of this legislation had said that this
would be very expensive, would cause companies to go out of
business, and that the cost of insurance was a problem. She
acknowledged that the cost of insurance was a problem, but that
the cost to add the benefit was "incredibly minimal," and that
the cost of claims data was even lower than the actuarial cost
predictions. She directed attention to page 14 of the handout,
"Insurance Coverage for Autism in Alaska," [Included in members'
handouts] which listed the premium costs in five of the earliest
states to adopt autism legislation. The first year of
implementation of autism legislation increased the per member
per month insurance cost by an average of 15 cents, and the
second year the average cost increase was 31 cents. She
declared that most everyone was willing to pay an additional 31
cents each month "so that all the children with autism could get
the treatment that they need, especially when it's such a
fiscally responsible thing for the state to do."
3:23:05 PM
MS. UNUMB furnished slide 12, "South Carolina State Employee
Plan," and stated that the original projection of cost to the
state had been $18.9 million, revised down to $10 million, with
an actual cost of $856,371 in the first year, and $2,042,392 in
the second year, which was 44 cents per member per month.
3:23:59 PM
MS. UNUMB directed attention to the handout "Health Coverage of
Alaska Population" [Included in members' packets] and said that
the proposed legislation would affect 15 percent of the state
population. She pointed out that the state could not regulate
the 34 percent of self-insured. She declared that the military
insurance in Alaska, TRICARE, which covered 11 percent of the
state, had already voluntarily adopted this same coverage. She
offered an analogy for using the too few available life jackets
to save as many people as possible from a sinking ferry, as
opposed to holding on to the lifejackets because there were not
enough to save everyone. She declared that the proposed bill
was that lifejacket to many families. Directing attention to
slide 24, "Self-Funded ERISA Plans that cover Autism Treatments,
" she pointed to a list of self-insured companies, not subject
to state law, that had voluntarily added an autism benefit when
the state had required the benefit.
3:26:47 PM
MS. UNUMB declared that the argument that this proposed
legislation targeted small businesses was misleading, as it
applied to all businesses that the state could regulate. She
urged immediate action on the proposed legislation, as any delay
could mean the difference to a child for a life time of
institutionalization or a meaningful lifetime.
3:27:41 PM
REPRESENTATIVE HERRON asked if the Michigan autism legislation
model fit with this legislation.
MS. UNUMB, in response, explained that Michigan had created a
state autism fund which reimbursed the insurance companies for
any additional costs from the coverage.
REPRESENTATIVE HERRON asked what was the response by the
insurance companies.
MS. UNUMB replied that the insurance companies were thrilled.
3:29:14 PM
CHAIR KELLER expressed his agreement that the fund concept
seemed so logical. He asked about any ramifications from the
federal Patient Protection and Affordable Care Act (PPACA). He
offered his belief that insurance mandates would be paid by each
state, without any federal match.
3:29:51 PM
MS. UNUMB directed attention to slide 30, "Impact of Federal
Health Care Reform," and clarified that PPACA stated that a
state would be "on the hook" for any benefits which the state
required unless those benefits were included in the federal
essential benefits package.
MS. UNUMB indicated slide 31, "federal Health Care Reform: The
Essential Benefits Package (pre-amendment) which listed the
essential benefits in PPACA, as it was going through Congress.
When Autism Speaks reviewed the list, it was unclear if autism
benefits were included, so language had been added, "including
behavioral health treatments," to ensure that autism treatments
were covered. She moved on to slide 33, "Federal Health Care
Reform: The Essential Benefits Package (as enacted)," which
included behavioral health treatment, as well as rehabilitative
and habilitative services. She emphasized that proposed SB 74
would be included in the federal PPACA essential benefits
package, and should not include any obligation for the state to
defray excess costs.
3:31:57 PM
CHAIR KELLER offered his belief that, as the outcome of PPACA
was an unknown, it was "an unsettled segment." He opined that
ABA should be included in special education funding, and asked
if other states had done anything toward this line of funding.
3:32:51 PM
MS. UNUMB explained that the federal Individuals with
Disabilities Education Act (IDEA) required that all public
schools accommodate children with disabilities, which included
autism. She pointed out that it did not require treatment for
the underlying disability. She informed the committee that
prior to IDEA, schools could "shut their doors to children with
disabilities," and that the intent of the legislation was for
schools to accommodate the disability, but not provide the
treatment. She declared that, if a family had health insurance,
it was the responsibility of the insurance company to contribute
to the treatment cost. She said that although some schools used
the principles of ABA in education, that lower threshold did not
meet the medical necessity threshold.
3:35:00 PM
MS. UNUMB, in response to Chair Keller, said that the revision
to the Diagnostic and Statistical Manual (DSM) was due to be
released in the near future. She offered her belief that it
would include a re-shaping of the autism spectrum; although
there was no intent to narrow the diagnosis, there was a concern
that this would be the effect.
3:35:30 PM
CHAIR KELLER clarified that the DSM was under consideration by
the American Psychiatric Association, and was due for release in
May 2013. He offered his belief that "we could do a more
intelligent bill just a little bit later."
MS. UNUMB replied that many states have had to grapple with
this, but that the definitions for the diagnoses would still
affect the same category of children.
3:36:46 PM
TONJA UPDIKE, Board Member, Governor's Council on Disabilities &
Special Education, offered a personal story her autistic child.
She declared that the early intervention program, the speech
therapist, and the occupational therapist had made great strides
with his development, but that, although he was now able to
speak, he was still not able to spontaneously converse. She
shared that the insurance benefits from her husband's job did
not cover a lot of her son's therapies. She emphasized that the
early age services for her son made a huge difference in his
development. She declared that the situation was very stressful
for a family, and that it was necessary to remember the impact
on the family and the children. She shared her dream for her
son to be an independent member of the community.
3:40:19 PM
MILLIE RYAN, Executive Director, Governor's Council on
Disabilities & Special Education, stated that the Council
strongly supported SB 74. She reported that the Council had
developed a five year autism plan "focused on universal
screening, expanded diagnostic capacity, enhanced information
and referral resources, work force development, and funding."
She summarized that the Council considered that parents, health
insurance, education, and the state all had roles to ensure that
children with autism received necessary services in a timely
manner. She declared that proposed SB 74 would make a major,
positive difference.
3:41:44 PM
BREEANN DAVIS shared a personal story of her son with autism,
the burden this placed on her family, neighborhood, schools, and
community, and the difficulties of constant supervision. She
declared that although ABA therapy was considered a proven, best
practice therapy, it was out of their financial reach. She
stated that her insurance would pay for medications and other
therapies, but would not pay for ABA. She declared that ABA
offered her son the best chance for a full life. She urged
passage of the proposed bill. She pointed out that, for a
family struggling to get through each hour, the postponement of
legislation until the next year "feels like a death sentence."
3:45:09 PM
CHRISTINE POTTER, President, Alaska Nurse Practitioners
Association, reported that the association was discussing the
introduction of an amendment to include advance nurse
practitioners as providers.
3:45:58 PM
AL TAMAGNI, National Federation of Independent Business (NFIB),
asked why small businesses, which represented 14-17 percent of
the insured in Alaska, were being singled out to pay for this
program. He offered his belief that large corporations did not
have to pay for this, as they were self-insured. He suggested a
need to review what was fair and equitable, and that the best
possible solution would be to set up the program under Medicaid,
as the cost would be equally spread.
3:49:24 PM
CHAIR KELLER asked if NFIB would accept for all the autism
coverage to be in a "blind pool" with the cost of the coverage
shared among everyone.
MR. TAMAGNI replied that NFIB would assist in drafting this
legislation.
CHAIR KELLER said that the state could then put money into the
fund.
3:50:41 PM
REPRESENTATIVE SEATON asked if NFIB would support the proposed
bill if the State of Alaska also included this benefit for its
employees.
MR. TAMAGNI replied that NFIB would be more interested in
"taking a look at it to where all entities participate in that
pool." He suggested that the money be deposited into a separate
pool or trust entity for Medicaid.
3:52:29 PM
REPRESENTATIVE SEATON asked to clarify whether all the NFIB
members qualified for Medicaid, or if NFIB only supported a
universal health care system that included Medicaid for
everyone.
MR. TAMAGNI replied that universal contributions to Medicaid
coverage for autism would be an idea.
REPRESENTATIVE SEATON, in response to Chair Keller, explained
that he was attempting to clarify the NFIB proposal. He offered
his belief that not all NFIB members would qualify for Medicaid.
He questioned whether Mr. Tamagni was proposing a universal
health care system, which he deemed to be a much larger issue
than was proposed in the current legislation.
3:53:50 PM
REPRESENTATIVE KERTTULA asked to clarify that insurance coverage
for autism was only for those that you insured, and did not
include everyone with autism.
MR. TAMAGNI expressed his agreement.
3:54:26 PM
ALLY BAKER, sharing that there was autism in her family, stated
her support for proposed SB 74. She reported that her son had
been diagnosed with autism, and she had only recently been able
to obtain health insurance to include her son, and received
approval for Medicaid benefits for him, as well. She declared
that the diagnosis process was extremely difficult. She stated
that her son had appeared to be normal until he was enrolled in
pre-school, and then he was not able to function in that social
setting. She explained that he had high functioning autism, but
that he lacked social skills and empathy, with a different
comprehension of social situations. She shared of her struggle
and challenges to find autism services, even with double
insurance coverage. She reported that he was now enrolled in an
integrated pre-school, and he was being taught how to interact
socially. She directed attention to the Centers for Disease
Control and Prevention (CDC) estimate that 1 in 54 boys had
autism. She stated that "it would cost people the price of a
gumball a month to insure that these services that can, that are
proven to teach our kids the skills that they need to have
productive and good quality lives." She asked that the
supporters in the audience for proposed SB 74 stand up.
[Approximately 35 people stood up]
3:59:19 PM
KATIE KING said that she was very appreciative of her family
support, that her mom, in Seattle, was her biggest supporter.
3:59:58 PM
LINDA HALL, Director, Anchorage Office, Division of Insurance,
Department of Commerce, Community & Economic Development,
referred to the pie chart of "Health Coverage of Alaska
Population" [Included in members' packets]. She declared that
any insurance mandate only applied to the 15 percent of the
insured programs which were state regulated, although many of
the self-insured programs would offer the mandated benefits.
She noted that Alaska had 15 insurance mandates, which did not
apply to Medicare, Medicaid, military, or Indian Health Service.
She reported that, generally, any ERISA (Employee Retirement and
Income Security Act of 1974) self-insured plan was not included
under the authority of the State. She expressed her concern for
any unrealistic expectations.
MS. HALL agreed that many entities which were not required to
offer a mandate often did so after it was adopted. In response
to Chair Keller, she said that nothing would prevent pool
coverage by insurance carriers.
4:04:12 PM
REPRESENTATIVE KERTTULA asked if the proposed autism coverage
mandate would be handled in the same manner as the other 15
mandates.
MS. HALL replied that some were mandatory offers, which meant
that although it had to be offered by an insurance company, it
was not included in all coverage.
REPRESENTATIVE KERTTULA asked how many insurance pools there
were in the state.
MS. HALL explained that ACHIA (Alaska Comprehensive Health
Insurance Association), the high risk pool, was funded by
assessments on insurers. She detailed that 50 percent of the
contribution was deductible by the insurance companies from the
premium tax, so, in effect the state was paying.
REPRESENTATIVE KERTTULA, noting that this was the only pool in
Alaska, offered her belief that it seemed unlikely for a pool
idea to be worked out during the short remainder of the
legislative session. She suggested starting with the mandate,
and then reviewing the need for a pool at a later date.
MS. HALL expressed her agreement that anything was possible.
4:06:29 PM
SHEELA TALLMAN, Premera Blue Cross Blue Shield, expressed policy
concerns for the proposed legislation previously outlined in a
letter dated April 6, 2012 [Included in members' packets]. She
stated a concern for the challenges of autism, and declared a
need to balance the interests of the families with autistic
members and the other insured members that Premera served. She
declared that autistic diagnosis received the same comprehensive
medical coverage provided to all the members, which included
mental health services, and rehabilitation services: physical,
occupational, and speech therapy. She pointed out that federal
health care reform allowed that children diagnosed with autism
were guaranteed access to private medical insurance without any
pre-existing condition exclusions. She pointed out that the
proposed legislation did not extend to State of Alaska employee
health insurance, the Indian Health Services, Medicare,
Medicaid, self-insured groups, or the federal employee benefit
plan. She declared that the proposed bill imposed an expensive
mandate only on private insurance coverage, about 15 percent of
Alaska residents. She declared that the self-funded plans had
the option to include this benefit. She reminded the committee
that the subsidized cost for any new mandate passed by a state
had to be paid by the state unless it was included as a part of
essential health benefits, as determined by the federal health
care reform. She noted that it was still unclear as to what was
included in essential health benefits and behavioral health
services. She reported that almost 47,000 Alaskans would be
subsidized by the federal government when the insurance exchange
was implemented in 2019, and the State of Alaska would be
financially responsible for covering the autism costs for these
individuals, in addition to any cost increase for Medicaid
expansion.
4:10:41 PM
MS. TALLMAN pointed out that Washington State and Oregon had
considered similar autism mandates, and that neither had passed
the mandate, primarily due to the estimated cost impact to the
state employee plan. She agreed that earlier identification for
autism would lead to better outcomes, although it would impact
medical service utilization and cost. She declared the
necessity to evaluate both the short and long term costs of the
proposed bill.
4:12:10 PM
MS. TALLMAN, in response to Representative Herron, said that she
had read a little bit about the Michigan incentive plan and that
it was a valid concept to be reviewed. She agreed that the idea
should be explored for better understanding, offering that
Premera would work on any future legislation.
4:13:41 PM
REPRESENTATIVE KERTTULA pointed to an apparent disagreement
between Ms. Tallman and Ms. Unumb about the possible state
requirements from the federal law.
MS. TALLMAN expressed her agreement that the federal law could
change.
REPRESENTATIVE KERTTULA asked about the difference in the
reported cost of "per member per month" from Ms. Tallman and Ms.
Unumb.
MS. TALLMAN said that the Premera analysis focused on its
specific membership and its current plans and premiums. She
said that some of the other actuarial analyses looked at a
broader market.
REPRESENTATIVE KERTTULA asked what the Premera analysis had
determined to be a "per member per month" cost.
MS. TALLMAN replied that she did not have that specific
information, but that analysis had estimated it to be about 3
percent, specifically on the individual and small group
purchasers.
4:15:13 PM
CHAIR KELLER stated that the bill would be held over.