Legislature(2009 - 2010)BUTROVICH 205
03/15/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB307 | |
| SCR13 | |
| SB250 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 307 | TELECONFERENCED | |
| *+ | SB 250 | TELECONFERENCED | |
| *+ | SCR 13 | TELECONFERENCED | |
SB 250-INS. COVERAGE: AUTISM SPECTRUM DISORDER
2:20:05 PM
CHAIR DAVIS announced consideration of SB 250. She asked
Representative Peterson if he would like to present the
companion to SB 250, which he introduced in the House.
REPRESENTATIVE PETE PETERSEN, sponsor of HB 187, encouraged the
committee to ask questions of the autism experts that were
online.
CHAIR DAVIS said it was not her intent to move the bill today.
She asked Mr. Obermeyer to present the bill.
2:22:13 PM
TOM OBERMEYER, staff to Senator Davis, said he was speaking to
the committee substitute (CS) for SB 250, labeled 26-LS1400\R.
He read the sponsor statement into the record. [A copy is in the
bill file.]
He related that SB 250 mandates coverage for diagnosis and
treatment of autism spectrum disorders (ASD) in any plan offered
by the health care insurer. Early treatment has been shown to
improve the symptoms of ASD and sometimes eliminate the need for
special education for a child with ASD. This is the proper way
to deal with this problem and it saves a great deal of money,
Mr. Obermeyer said.
MR. OBERMEYER pointed out that self-funded health plans,
including the "Alaska Care" plan, would likely be exempt from
the bill because they are preempted by the federal ERISA law.
However, the state historically has complied with state
insurance laws.
The Center for Disease Control (CDC) reports that about 1 in 110
children are affected by ASDs, but it is much more prevalent
among boys. This is an increase from 10 years ago, but it's
unclear if this increase is due to a broader definition of ASDs,
better diagnoses, or a combination. Many children who have been
diagnosed go untreated because ASD often is not covered by
insurance plans. The cost to families is overwhelming.
MR. OBERMEYER related that the federal Autism Treatment
Acceleration Act of 2009 is pending legislation and implementing
SB 250 now would allow insurers and the state time to adjust to
the requirements of this law. Also, he said, it would bring
health care professional and jobs to the state. Since March of
2009, 11 states have passed legislation similar to SB 250 and 19
states have introduced legislation. SB 250 will significantly
help the hundreds of Alaskans suffering from these disorders, he
concluded.
2:29:19 PM
SENATOR PASKVAN moved to adopt the proposed committee substitute
(CS) for SB 250, labeled 26-LS1400\R, as the working document.
There being no objection, version R was before the committee.
2:29:44 PM
LORRI UNUMB, Senior Policy Advisor and Counsel, Autism Speaks,
Columbia, South Carolina, said this is a national autism
science, research, and advocacy organization. She informed the
committee that she is a former law professor and the parent of a
child with autism; she now advocates full time for children with
autism and work nationwide on autism insurance reform. She noted
that she would speak to the PowerPoint handout in the packets
focusing on the experience in other states that have passed
autism insurance reform.
Slide 6 depicts a map of the U. S. showing the states that have
passed autism insurance reform. At Autism Speaks they consider
that 15 states have enacted meaningful reform, she said. In
these states kids can get the kind and close to the amount of
therapy that's been prescribed for them. Indiana and Minnesota
passed legislation in 2001 so cost data is available, but it's
nearly ten years old. South Carolina and Texas were the next
states to pass legislation in 2007; more states followed suit in
2008 and 2009. As previously mentioned, legislation is pending
in 19 states.
MS. UNUMB directed attention to slide 7 that contains excerpted
data from an insurance advocacy association report titled
"Health Insurance Mandates in the States." It indicates that
covering autism has impacted premiums by less than 1 percent.
This is compared to other mandated treatments like alcoholism,
contraceptives, in vitro fertilization, and prescriptions all of
which are higher.
Slide 8 contains actual cost data from South Carolina after the
autism insurance statute became applicable to the state employee
health plan in January 2009. The state has a population of 4.5
million and the state employee health plan has 350,000 members.
When the legislation was introduced the state budget office
initially estimated that this coverage would cost the state
$18.9 million and that was later revised down to $9 million. The
actual claims date for all of 2009 shows that it cost the state
$856,371. This translates to a 20 cent premium increase per
member per month to provide all the kids with autism in South
Carolina with the coverage they need. The South Carolina statute
is a little different than what SB 250 proposes because it
provides coverage only through age 16 and it caps applied
behavior analysis (ABA) therapy at $50,000 per year. The Harvard
study indicates that the lifetime cost for each child with
autism who does not get treated is $3.2 million so if you're not
motivated by the human aspect, think about if from the fiscal
perspective, she said. Fully 50 percent of the kids who receive
treatment will go right into a mainstream first grade classroom,
saving the state an awful lot of money, she concluded.
2:38:42 PM
SENATOR PASKVAN asked what policy issues caused [South] Carolina
to cap coverage at age 16 and $50,000.
MS. UNUMB replied she selected age 16 somewhat randomly without
any scientific basis. Most of the states that have reform
selected age 18-22. The original legislation didn't have a
therapy cap, but the insurance industry argued in favor of one
on the ABA therapy because they couldn't estimate that cost.
When the legislature asked her to write in a cap, she put in
$75,000 because that's the cost of her son's therapy. Shortly
before the bill passed the cap was negotiated down to $50,000.
Slide 10 has a chart comparing the age and ABA therapy caps in
six states with reform statutes. She offered to provide a chart
that compares all 15 states in some detail.
CHAIR DAVIS said that would be helpful.
2:42:18 PM
SENATOR DYSON questioned why treatment for this disability isn't
paid for out of the tax base as opposed to insurance. Here in
particular it would be a very selective and disproportionate
sharing of the burden.
MS. UNUMB replied some states have attempted to provide coverage
through the Medicaid waiver program, but it isn't sufficient to
treat all the kids. Even with a very favorable 70 percent
federal match, South Carolina has two to three year waiting
lists of several hundred children. That doesn't do a child with
autism any good because the early intervention window is
critical for rewiring the brain. She added that autism is at
core a medical issue and for the people who have private
insurance it seems only fair that private insurance play a part.
SENATOR DYSON thanked her for a thoughtful response.
2:46:24 PM
SENATOR THOMAS referenced the actual 2009 cost data she provided
for the South Carolina state employee plan and expressed
disbelief that treatment per child could cost so little. He
asked how she arrived at $856,000.
MS. UNUMB said she believes that cost will rise as more people
take advantage of the coverage, but she doesn't it will ever
approximate the state's $9 million estimate.
She referenced slide 2 showing the five pervasive developmental
disorders (PPD). Within the five PDDs there are three autism
spectrum disorders (ASDs): autistic disorder, Asperger's
syndrome, and pervasive developmental disorder - not otherwise
specified (PDD-NOS). Autistic disorder accounts for 1/3 of all
ASDs, Asperger's syndrome accounts for less than 1/6 of all
ASDs, and the milder PDD-NOS accounts for 1/2 of all autism
spectrum disorders. The kids in the first category are severe
and they are prescribed the intensive behavioral therapy. While
the prevalence of PDD is 1 in 110, only 1/3 have a severe
diagnosis and only some of those will be prescribed a full 40
hour per week ADA therapy program. And not all of the ones who
are prescribed the intensive program will take advantage of it
because it takes place in your home and is incredibly intrusive.
Not every family is willing to make the lifestyle adjustments
and in rural areas there may be provider issues.
One reason that South Carolina's fiscal note was so far off is
that the budget analyst took the prevalence number and
multiplied it by the cap. They assumed that every child would be
prescribed and get the maximum treatment, but it doesn't work
that way. In South Carolina 62,000 kids were within the age 2-16
target range and just 64 were actually prescribed and took
advantage of the therapy in 2009.
SENATOR THOMAS asked if she has examples from other states that
have had legislation in place for a longer period of time and
why she included a slide that lists businesses that have self-
funded ERISA plans.
2:53:07 PM
MS. UNUMB said it's difficult to get detailed data because
private insurers are less forthcoming, but she does have data
from Minnesota. That benefit has neither an age nor a dollar cap
and it's been in effect for nine years. Blue Cross/Blue Shield
said that the average utilization on an ABA program was $30,000
per year and the premium increase has been $.83 per member per
month. She noted that Autism Speaks hired an independent actuary
to conduct an analysis on the companion bill to SB 250 and he
projected a cost of $1.34 per member per month.
She explained that she included the information on the ERISA
plans because she likes to point out that when a state chooses
to mandate a benefit many ERISA regulated plans voluntarily
follow suit. The slide offers a small list of companies that
have elected to provide an autism benefit. She believes that the
Microsoft administrator is Premera Blue Cross Blue Shield and
she understands they are a predominant insurer in Alaska.
SENATOR PASKVAN asked if there's a rational explanation for some
states placing a different dollar cap on therapy based on age.
MS. UNUMB replied they're the result of a political process.
Some states have decided that kids don't need as much treatment
once they enter school and that might be true depending on
severity.
2:57:28 PM
SHEELA TALLMAN, Legislative Affairs, Premera Blue Cross Blue
Shield of Alaska, confirmed that this legislation will not
impact self-funded plans, which are subject to ERISA and it's
not subject to state mandates. However, the bill will impact the
40 percent of the market that represents individuals and small
employers in Alaska that are already price stressed. It imposes
a mandate on health insurers like Blue Cross by requiring all
policies to include coverage for ASDs including social skills-
based therapies that generally considered outside the realm of
health care. They estimate that this mandate could increase
health insurance premiums up to 3 percent so it's not cost free.
2:59:15 PM
SENATOR PASKVAN asked if she disputes the estimated $1.34 per
person per month premium increase.
MS. TALLMAN replied they believe it will be slightly higher but
she doesn't have the exact number.
SENATOR PASKVAN asked if the premium would likely be lower if it
were spread over a larger population base.
MS. TALLMAN replied their calculations already include the small
and large groups of insured.
CHAIR DAVIS asked if she could meet with the committee again and
provide the additional information.
MS. TALLMAN agreed to do so.
CHAIR DAVIS held SB 250 in committee.
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