ASA Publishes Model Legislation for Autism Insurance Coverage

February 12, 2009

By: Carin Yavorcik, ASA

The Autism Society of America published today its "Model Legislation for Insurance Coverage," with the goal to strengthen and continue the quest for appropriate insurance coverage for all Americans living with autism.

ASA estimates the lifetime cost of care for an individual with autism at $3.5 to $5 million; with access to early diagnosis and intervention, these costs can be reduced by two-thirds. However, these interventions are costly - upwards of $40,000 a year - and often not covered by insurance. Many families simply cannot afford to give their children the treatments that could help them reach their fullest potential.

"Families are drowning under the cost of autism treatments that are not covered, and states and companies are looking for ways to cover a complex, individualized medical condition," said Lee Grossman, President and CEO of the Autism Society of America. "We feel that this model legislation offers clear, practical solutions that will allow all parties to work together to serve this growing community."

At this time, only eight states have risen to address this injustice by passing legislation requiring insurance companies to provide coverage for autism spectrum disorders, though more than 35 states currently have similar bills working their way through the legislature. These desperately needed pieces of legislation face many hurdles before they become law. Only recently, insurance bills in Oklahoma and Virginia have been defeated.

"Autism is a medical condition impacting the quality of life of my 14-year-old twin sons. In terms of coverage, this condition should not be treated differently than diabetes, leukemia or anything else that would require medical treatment and appropriate services," said Jeff Sell, Vice President of Advocacy and Public Policy for the Autism Society of America. "Autism treatment and services should be covered by private health insurance just like those other medical conditions. This is simply the right thing to do on several levels."

ASA's model legislation clearly outlines the best language to use in order to make sure that those affected by autism receive the treatments they need. This model will be especially helpful for lawmakers currently considering insurance bills, advocates currently developing legislation and supporters of shelved bills who have been forced to regroup.

Key points include detailed and flexible definitions of what should be legally included in terms like "autism spectrum disorders" and "medically necessary." It also stipulates that legislation should not include arbitrary age limits or artificial dollar caps, states that insurance companies may not discriminate against individuals with autism spectrum disorders based on their diagnosis of ASD, and gives a suggested "laundry list" of covered therapies, including but not limited to evaluation and assessment services, behavior training and behavior management (such as Applied Behavior Analysis), habilitative or rehabilitative care (such as speech or occupational therapy), and medication or nutritional supplements used to address symptoms of autism spectrum disorder.

Read the Model Legislation in its entirety.