Kansas Lawmaker Wants To Adjust Law Mandating Autism Coverage | KCUR

Kansas Lawmaker Wants To Adjust Law Mandating Autism Coverage

Nov 11, 2014

The Kansas House member who last session championed a bill that expanded insurance coverage for autism treatment said it may be adjusted in the upcoming legislative session.

Rep. John Rubin, a Shawnee Republican who was re-elected last week, said he will propose changes to House Bill 2744, which was a compromise struck between insurance companies and autism treatment advocates.

“We’re going to continue on it,” Rubin said of the autism bill. “As with a lot of kind of significant legislation, there’s some cleanup that I think needs to be done.”

The bill passed last session was expected to extend coverage to about 750 Kansas children from birth to age 5, which is about 20 percent of those estimated to need such treatment in the state. The new mandate requires insurance companies to cover up to 25 hours per week of a therapy known as applied behavior analysis treatment.

Rubin said when the legislative session begins in January, he will push to loosen licensure requirements established in HB 2744 that restrict who can provide the treatment.

“I recognize it was part of the compromise to get the bill passed last year, but I just don’t think it’s necessary,” he said. “I actually think it’s interfering with the intent of the legislation to provide the services, because there will be fewer providers available.”

Mike Wasmer, director of state government affairs for the advocacy group Autism Speaks, said the licensing requirements were added at the end of the process by the health insurance lobby. His group is hosting a meeting of autism treatment providers Dec. 5 at the University of Kansas Edwards Campus to discuss potential changes to the law.

“We want to take it out but then introduce a licensure piece with the benefit of thoughtful input from the provider community and consumers,” Wasmer said.

Rubin said he'd also like to expand upon the coverage mandated by HB 2744, but said that might be a difficult proposition without changes to the federal health care reforms spearheaded by President Barack Obama.

The bill passed in Kansas last session requires large-group insurance plans to offer the autism coverage starting Jan. 1, while individual and small-group plans that are grandfathered into the federal Affordable Care Act must offer the coverage starting in July 2016.

The provisions in HB 2744 did not affect large-group, self-insured plans in Kansas. Several of these employers’ plans — including Cerner, Garmin, Koch Industries and Children’s Mercy Hospital — already cover autism.

Rubin said he would like to see post-ACA individual and small-group plans require the treatment as well, but the federal law might make adding the autism coverage mandate prohibitively expensive.

Kansas did not choose in 2012 to include autism coverage as one of the mandated essential health benefits for plans to be sold in the online health insurance marketplace. If any new mandates, such as autism treatment coverage, are subsequently added to the plans on the marketplace, the federal law stipulates that the cost must be borne by the state.

Wasmer said his group has not received a clear answer from the U.S. Department of Health and Human Services on whether that means the state would have to pay all autism treatment claims for exchange plans or just the difference in premiums after adding autism coverage.

In either case, the state is facing a projected $278 million deficit in the current fiscal year, and taking on any new expenses appears unlikely.

“From a fiscal standpoint, that could be difficult,” Wasmer said.

Prior to this year, only the Kansas state employee health plan mandated coverage of autism treatments.

Rubin said he would like the “cleanup” bill to clarify that the limitations on the coverage set in HB 2744 do not apply to the state employee health plan.

“I thought we made it clear in the bill, but we’ll make it doubly clear next year,” he said. “Nothing in the bill applies to anybody that was previously covered under the state employee health system.”