FREQUENTLY ASKED QUESTIONS
One of the biggest difficulties that we face as advocates is the lack of a unified front in Concord. The NH Coalition for Autism Legislation is an effort to unify the legislative efforts of the autism community in NH and to insure that these are aligned with the goals of the NH Counsel on ASD and the broader disabilities rights community. Our intent is to put forward common sense solutions to the public health challenges posed by the rising incidence of ASD.
What would HB 569 do?
The proposed bill is fairly simple: ASD is a neurobiological condition for which there are medically necessary, evidence-based treatments. Connor's law defines those treatments in a manner aligned with guidelines that were
adopted by the American Academy of Pediatrics in 2007.
What treatments and services would be covered?
Testing to diagnose autism; Applied Behavioral Analysis (ABA) and other structured behavioral therapies; speech, occupational, and physical therapy; pharmacy care; and care by a psychologist or psychiatrist. These therapies would have to be provided by certified or licensed providers, and they would have to be prescribed by the treating physician or psychologist. Treatment could not be denied on the basis that it is not "restorative" in nature.
Why is legislation for autism insurance coverage warranted?
The NH legislature adopted a strongly worded mental health parity law in 1994. This means that insurance coverage for mental illness must be similar to that provided for physical illnesses. In 2002, the legislature added a number of biologically based mental illnesses to the list of conditions subject to the parity. PDD or autism was included.
However, at that time, there was less consensus as to what "treatment" meant in the case of ASD. Because of this confusion, many children in NH have not receive appropriate treatment, largely due to cost, according to the findings of the NH Commission on ASD (Spring, 2008). The American Academy of Pediatrics has since adopted a peer-reviewed set of guidelines to assist primary care doctors in counseling parents about best practice treatments for a child with ASD. Connor's Law defines aligns treatment with the recommendations of the AAP.
Isn't ABA experimental?
The science of applied behavior analysis (ABA) has been developed and practiced for over 40 years. Its efficacy is well established. The American Academy of Pediatrics stated in 2007:
The effectiveness of ABA-based intervention in ASDs has been well
documented through 5 decades of research . . . Children who receive
early intensive behavioral treatment have been shown to make
substantial, sustained gains in IQ, language, academic performance,
and adaptive behavior as well as some measures of social behavior,
and their outcomes have been significantly better than those of children
in control groups.
Why hasn't NH’s Mental Health Parity law guaranteed treatment of ASD?
New Hampshire has a strongly worded mental health parity law that specifically names autism as a “biologically-based mental illness.” While well intended, in reality this has had some limitations.
First, there is no specific mention of Applied Behavior Analysis. In the absence of specific guidelines, insurers have interpreted “treatment” in the context of the other mental illnesses referenced by this law such as schizophrenia and major depressive disorder — illnesses for which "treatment" is understood to mean an entirely different approach and set of goals. Research and medical opinion have shifted since the parity law was revised to include autism. The American Academy of Pediatrics now endorses early, intensive ABA-based interventions.
Second, the treatments of choice for ASD focus on deficits in communication, social engagement, and self-regulation. Insurance providers have identified these types of programs as “habilitative care,” which they generally do not cover.
Isn’t ABA an “educational intervention”?
Like speech and occupational therapies, ABA is frequently necessary in both an educational as well as a medical setting. ABA provided in a clinical setting addresses the core symptoms of autism, thus preparing the affected child to fully benefit from educational interventions. It should be noted that recent revisions to HB 569 include language that specifically protects against loss of services mandated by law under a Medicaid Part C funded Early Intervention Program (The “autism proposal”), an In Home Support Waiver, an Individualized Education Plan (IEP), or any other publicly funded program.
Won’t this law drive up the cost of premiums? How can we afford it at a time when the State is facing unprecedented budget cuts?
ASD is a spectrum disorder, meaning that it varies in the severity of its impact upon an individual. Some children diagnosed with ASD require more intensive treatment than others.
HB 569 was "retained for study" over last summer. At the request of the House Committee on Commerce and Consumer Affairs, the impact of Connor's Law on premiums was reviewed by an independent firm -- Compass Health Analytics from Portland, ME. Compass found that the impact on premiums would be between .2 and .4%. This translated to between 77 cents and $1.42/month/individual policy holder. This finding is consistent with many other studies conducted at the request of other states that have reviewed similar legislation.
Three other points about cost are worth mentioning:
(1) Connor’s law does not apply to the State of NH’s employee health insurance policy, which is self-funded and therefore regulated by the federal government (ERISA). The bill’s fiscal note finds no impact upon the state budget.(2) In the absence of appropriate insurance coverage, the state’s Department of Health and Human Services and our public schools have had to shoulder a disproportionate share of the cost associated with ASD. Neither of these systems were designed to be the primary provider of medically necessary treatment. In fact, when children receive the recommended level of structured, behavior-based therapy in early childhood, research has demonstrated that cost savings are realized even during adolescence — in other words, treatment can lower the cost of later special education services and community-based supports.(3) Still more importantly, HB 569 and legislation like it are part of an effort to address the long term cost of care. A 2007 study by Harvard School of Public Health researcher Michael Ganz, M.S., Ph.D. estimated that for a single individual, the lifetime cost—both direct and indirect—associated with autism is $3.2 million. Adult services account for most of that cost. Intensive, early treatment is the key to lowering future cost, by as much as 2/3rd according to one study.A cost benefit analysis of Connor's Law has been prepared by contacts through the Autism Society of America. This review, which used the same numbers generated by the Compass study, estimated long terms savings to be $597.8 million.What insurers would be impacted?
In its current form, HB 569 would apply to private insurers and HMOs operating in New Hampshire. ERISA plans (that is, companies that "self-insurer"), are subject to federal regulation and would not be affected by HB 569. It is important to note that at the federal level, the new administration has stated its intent to introduce revisions to ERISA that mirror those proposed by Connor’s Law and other state initiatives. These revisions will require Congressional support. The federal government has already modified TRICARE -- the health care program serving active duty service members, National Guard and Reserve members, retirees, their families, and survivors worldwide.
Where does HB 569 stand in terms of the legislative process?
HB 569 was reviewed by a sub-committee of the House Commerce Committee on Wednesday, Oct. 21. All 3 members expressed their support for the bill.
HB 569 is scheduled to go before the full House Commerce Committee on
November 12 and could advance to the House floor before the December Holidays.
SEEKING FULL AND FAIR COVERAGE FOR THE TREATMENT OF AUTISM
SPECTRUM DISORDERS IN THE GRANITE STATE
To read the acuarial impact study by Compass Health Analytics, click here.
To read the cost benefit analysis by Jon Hockenyos, click here.
