Pending Autism Parity Legislation in
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There is no required private insurance coverage for the diagnosis or treatment of ASD in Ohio. Some private insurance companies do provide coverage for autism treatment and autism related services including occupational therapy, physical therapy and speech language therapy.
The State of Ohio, through different Medicaid waivers and Medicaid card services, pays for certain autism services. Services for children ages 0-3 are covered through the Ohio Department of Health Help Me Grow Program and ODDD Early Intervention Services. Services for children ages 3+ and adults are delivered through ODDD. Limited services are covered through the Ohio Department of Health, Bureau of Services for Children with Medical Handicaps (BCMH). BCMH provides funding for services, diagnosis and treatment of children with medical conditions that are medically eligible. For example, children with ASD sometimes have other medically eligible conditions like seizures, hearing loss, and gastrointestinal problems, which can be covered by BCMH. Additionally, parents can obtain a time-limited diagnostic enrollment that will pay for autism testing and assessment services. Some autism treatments are available as covered services under Medicaid waivers administered by ODDD or the ODJFS - although there are waiting lists for these waivers numbering in the thousands.
Because Ohio law does not require insurance coverage for ASD treatment, families that do not qualify for Early Intervention Services and/or ODDD services pay for services out of pocket, often tens of thousands of dollars per year. Families that cannot afford to do so may go without crucial interventions.Bearing this burden, and navigating the very complicated system of state-funded coverage results in enormous strain on families, often resulting in divorce and even bankruptcy.
Autism Insurance parity was a recommendation of the legislatively created Ohio Autism Taskforce. To read the complete report of the taskforce, click here
To read the 2007 ODDD Status Update on the OAT Recommendations, click here .
ASO has taken on the OAT report as a blueprint for advocating for services for persons with autism and their families in Ohio. Autism Insurance Parity is a top priority.
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Pending Autism Parity Legislation in Ohio
H.B. 8
In December, the Ohio House passed HB8 affecting autism insurance coverage. This bill prohibits health insurers from excluding coverage for specified services for individuals diagnosed with an autism spectrum disorder. The Autism Insurance Coverage bill - House Bill 8 - was passed by the Ohio House on December 14, 2009. Covered services under the bill include:
- Habilitative or rehabilitative care (which would include therapies like Applied Behavior Analysis)
- Pharmacy care if the policy, contract, or agreement provides coverage for other prescription drug services
- Psychiatric care
- Psychological care
- Therapeutic care
- Counseling services
The bill also includes a $36,000 annual cap on benefits, requires providers to be licensed or work under a licensed provider, delays the effective date of the legislation until January 2011 and allows for six-month reviews of treatment plans by health insurance companies.
For the complete verbiage of the bill, click here: H.B. 8 - Health Insurance Parity for Persons with Autism.
The bill is has now moved to the Ohio Senate and is before the Senate Insurance, Commerce and Labor Committee. To see which members comprise the committee, click here. The bill must be recommended by a majority of the committee before it can be considered by the entire Ohio Senate.
The Ohio Legislative Services Commission has prepared a Fiscal Note and Local Impact Statement of H.B. 170. HB 170 was the predecessor of HB 8 in the previous General Assembly. If and when a new fiscal note is prepared, it will be posted. This fiscal note is provided for reference only. Click here to see the fiscal note: Fiscal Note and Local Impact Statement of H.B. 170
Latest Information - ASO Blog
December 8, 2009: HB8 referred to the Ohio Senate Insurance, Commerce and Labor Committee for consideration.
December 8, 2009: OH House amends and passes HB 8!
July 13, 2009: Autism Insurance Coverage Language Removed from HB1 in compromise with Conference Committee
April 28, 2009: HB 8 Amended into Ohio Budget Bill HB 1.
April 1, 2009: HB 8 amended and passed by House Healthcare Access and Affordability Committee. Bill heads to House floor.
March 31, 2009: Fourth hearing held on HB 8 in the Ohio House Health Care Access & Affordability Committee.
March 25, 2009: Third hearing held on HB 8 in the Ohio House Health Care Access & Affordability Committee. No vote is held.
March 18, 2009: Second hearing held on HB 8 in the Ohio House Health Care Access & Affordability Committee. No vote is held.
March 11, 2009: First hearing held on HB 8 in the Ohio House Health Care Access & Affordability Committee. No vote is held.
February 17, 2009: Autism insurance reform bill, House Bill 8, introduced by Representative Ted Celeste (D-24) and Representative Nancy Garland (D-20) in the Ohio House. Bill is referred to the House Healthcare Access & Affordability Committee
Action Alerts
2009-11-06 Auitsm Society of Ohio Action Alert: Contact Speaker Budish Today!
2009-11-05 Autism Society of Ohio Action Alert: Autism Insurance Coverage in Ohio
2009-11-05 ASO OAAN Action Alert - Autism Insurance Coverage - Easy to Use Link Now Available
2009-10-27 Autism Society of Ohio OAAN Action Alert: Ohio Autism Insurance Coverage
2009-10-02 ASO - OAAN Action Alert: The Fight is On for Long Term Services and Supports
2009-07-15 ASO Legislative Update: Autism Insurance Coverage Removed from HB 1
2009-07-13 ASA-ASO OAAN Alert: Autism Insurance Coverage Language Removed from HB1
2009-07-02 ASA-ASO OAAN ALERT: Federal Health Care
2009-06-11 ASA-ASO ACTION ALERT: Autism Insurance Coverage is close - Help Now!
2009-5-15 ASA-ASO OAAN Action Alert: Autism Treatment Acceleration Act Introduced in U.S.
2009-05-14 ASA-ASO Action Alert: Contact your Senators about HB 1
2009-04-28 ASA-ASO Action ALERT: HB 8 Amended into Ohio Budget Bill HB 1
2009-03-30 ASA-ASO ACTION ALERT: HAA Committee to Possibly Vote on HB8
2009-03-24 ASA-ASO ALERT: Autism Insurance Coverage Hearing Important Notice
2009-03-20 ASA-ASO ACTION ALERT: 3rd Autism Insurance Coverage Bill Hearing Scheduled
2009-03-12 ASA-ASO OAAN ALERT: 2nd Autism Insurance Coverage Bill Hearing Scheduled
2009-03-04 ASA-ASO ACTION ALERT: HAA Committee Recommends HB8 to Full House
2008-12-08 ASA-ASO ACTION ALERT: Autism Insurance Parity Update
2008-03-25 ASA-ASO ACTION ALERT: Ohio Autism Insurance Parity Hearing
2008-02-20 ASA-ASO ACTION ALERT: Join us for Presidential Town Hall on
2007-12-14 ASA-ASO ACTION ALERT: Autism Insurance Parity Update
2007-10-12 ASA-ASO ACTION ALERT: Autism Insurance Parity Introduced
Get Involved
Sign Up for Action Alerts and to Provide Information
The ASA-Autism Society of Ohio and the Ohio Autism Coalition (a coalition of autism advocacy groups in the state) support this legislation. The ASA-Autism Society of Ohio Public Policy Committee is organizing efforts to pass HB170. In order to more effectively advocate for this legislation, we need your help! We will be developing a database of Ohio residents that could assist us.
If you are willing and/or able to:
· provide a story related to autism services from your heath insurance company
· provide a letter of denial from your insurance company
· provide a copy of your health insurance policy that contains language specifically excluding autism
· testify in Columbus at committee hearings
· write letters to legislators
· come to the statehouse to support others testifying or for rallies
· meet with legislators, either in Columbus or your local area
We need your help!
Join the ASA-ASO OhioAutism Advocacy Network
Please provide the following information via email: Name, address, city, zip+4, phone, email address, state representative and state senator. Not sure of your zip+4 - click here then click on "find a zipcode" and enter your address. Not sure of who your state legislators are - click hereand follow the directions under "Locating Legislators". Cut and paste the items that you can help with from the above list into your email and send to
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- please put INSURANCE PARITY in the subject line. If you wish to participate, but would like to remain anonymous when working with legislators, please still send us your contact information so we can alert you as to when your help is needed - and you can respond to your legislators anonymously. Just note with your contact info that you would like to remain anonymous.
If you would like to receive email alerts on other autism related topics, click "HOME", and register in the "Login" section on the upper right corner of the page.
Help Educate Your Legislators
Many legislators do not understand or know much about autism. Nor do they understand the problems families face trying to get medical treatments for their loved ones with autism. In order to get Autism Insurance Parity passed in Ohio, we will need to educate our Ohio Legislators! Please contact your legislators and provide them with one of the "Frequently Asked Question" sheets below. Not sure of who your state legislators are - click hereand follow the directions under "Locating Legislators".
ASO has participated in an Autism Caucus in both the Ohio House and the Ohio Senate. All legislators were provided with information about autism. But it is important for constituents to make contact with their specific legislators to make the issue of autism personal. Download any of the information sheets listed to provide autism information to your legislator.
Information Sheets:
ASO: Frequently Asked Questions, Facts about Autism
ASO: Frequently Asked Questions, House Bill 8
Talking Points on Autism Insurance Coverage
Autism Speaks: Arguments in Support of Private Insurance Coverage of Autism-Related Services
Make Your Voice Heard!
What can you do NOW to help in this effort?
A few suggestions:
- Meet with your legislators when they are in district (usually Mondays and Fridays) and share information about autism. Be brief and positive!
- Use the information listed above to help educate your legislators.
It is a legislator's job to represent the interests of his/her constituents, so make your voice heard! If you need help, there are plenty of resources out there.
A few things to consider:
- For a course "Making Your Case" from Partners in Policymaking for effectively communicating with your legislators and others, click here.
- For a "Making Your Case" Handbook from the Minnesota Governor's Council on Devleopmental Disabilities (generic and useable for Ohioans), click here.
- Click here for Do's and Don'ts from the Disability Policy Collaboration
General
2009-01-11 The San Francisco Chronicle: California parents sue insurance company over autism coverage
2008-10-17 CNN.com Parents press for autism insurance coverage
2008-09-16 Boston Globe: Push on for insurers to share autism costs
2008-07-08 LA Times: Who pays for autism treatment?
2008-05-08 Chicago Tribune: Parents of children with autism are often invisible casualties
2008-04-27 Wall Street Journal: Hard Choices About a Child's Special Needs
2008-04-02 Medical News Today: Autism: Out-of-pocket Expenses, Missed Income Opportunity Levy Double Burden On Families
2008-04-01 CNN: Mom Wins Fight for Autism Insurance
2008-04-30 Stateline.org: Parents turn to states for autism help
2008-03-24 ABC News: Insurance vs. Autism: For Parents, Insurance Is a Personal Fight
Ohio
2007-11-08 Autism Bulletin: Ohio House Takes Up Autism Insurance Parity Bill
2007-09-06 Columbus Dispatch: Lawmakers Push to Cover Autism in Health Plans
Other States
2010-05-12 The Kansas City Star: Autism-insurance bill heads to Missouri governor for signature
2009-11-08 Cape Cod Times (Cape Cod, MA): Massachusetts considers bill to expand insurance coverage for autism
2009-08-13 The Star-Ledger (Newark, N.J.): New Jersey requires insurers to cover therapy for autistic children
2009-11-03 WSMV-TV (Nashville, Tenn.): Bill to expand autism insurance coverage is under review in Tennessee
2009-08-06 KMBC-TV (Kansas City, Mo.) / The Associated Press: Missouri governor supports insurance plan for autistic children
2009-03-09 Detroit News: Blue Cross ordered to defend stance on autism therapy coverage
2009-03-05 Seattle Times (AP): Missouri lawmakers seek to mandate autism coverage
2009-02-12 Washington Post: Autism insurance bill halted in Virginia Senate
2009-02-06 Billings Gazette: Mandatory autism insurance would save Montana money
2009-02-02 Washington Post: Virginia parents plead for mandatory autism insurance
2009-01-19 The Oklahoman: Oklahoma Legislature may take up autism-insurance bill
2008-07-18 Health News: Illinois Leading the Fight Against Autism
2008-05-08 Panama City, Fl, News 7: Autism Bill Passes
Health Insurance Guides and Information for Ohio Stakeholders
- Choosing and Using a Health Plan: A Consumers's Guide
- Ohio Health Care Safety Net - A Description of Public and Private Programs
- Appeals Process: What Happens if Your Insurance Company Says No
- Shopper's Guide to Health Insurance & HMOs (This guide is being revised by the Ohio Department of Insurance and will be available soon. We apologize for the inconvenience.)
- What is the Health Awareness Portfolio?
- Other Strategies for Funding
- Letter of Medical Necessity: What Providers Need to Know
- Insurance Communications Log
(Information provided by the ASA-Autism Society of Colorado)
Insurance Coverage-on-a-Budget Links (some links provided by TACA)
· How to Start Working with Your Insurance Company
· Appealing an Insurance Denial
· What is ERISA-Employee Retirement Income Security Act?
· Tax Strategies for Parent of Children with Special Needs
· Definitions Relating to Insurance
National Insurance Issues
- Sign a national petition to encourage candidates for National Office to find a health care solution - click here.
- Mental Health Parity - Negotiations continue to attempt to reach agreement on House and Senate mental health parity legislation (S. 558, H.R. 1424). The House approved its mental health parity bill by a 268-148 vote on March 5. The Senate approved parity legislation in September 2007 by unanimous consent. On March 18, Senators Kennedy (D-MA) and Domenici (R-NM) offered the House a compromise. It was reported last week that the House has prepared a counteroffer to a Senate proposal on mental health parity legislation. A major sticking point has been House language requiring employers to cover all illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). For complete information on the bill, click here.
