Pennsylvania autism law praised as model for other states

Autism law praised as model for other states
www.pittsburghlive.com/.../s_577096.html
By Liz Hayes
VALLEY NEWS DISPATCH
Friday, July 11, 2008

Autism advocates are hailing the long-awaited passage of a state bill that requires insurance companies to start covering autism treatments next July.

House Bill 1150 -- named for the estimated 1 in 150 children now diagnosed with the neurological disorder -- requires insurance companies to provide up to $36,000 in annual benefits for autistic children and young adults up to age 21.

Those benefits will include coverage of diagnosis and therapies that experts believe can lead to improvement in behavior, communication and learning disabilities -- the hallmarks of autism spectrum disorders.

Historically, behavioral therapies were not insured because they were not considered medically necessary. Many families relied on a loophole program through the state Department of Public Welfare that allowed them to qualify for medical assistance, regardless of family income.

"I'm very happy with (the bill)," said Cindy Waeltermann, president of the Autism Center of Pittsburgh and mother of two autistic boys. "We worked so many years to get it passed."

Waeltermann spoke Thursday as she drove home from Hershey, where she and her sons, Alex and Christopher, were present on Wednesday when Gov. Ed Rendell signed the bill into law.

"By requiring private health insurers to shoulder their fair share of the cost of treatment," Rednell said, "we're taking steps to address the gap in the private insurance market and reduce reliance on government programs as the primary source of services and funding."

The bill was sponsored by state Sen. Jane Clare Orie, R-McCandless, and House Speaker Dennis M. O'Brien, R-Philadelphia. Orie indicated the law could become a model for other states to follow.

"This bill will end discrimination for individuals with autism," Orie said. "(It) provides them the same medical necessity standards provided to those with cancer, diabetes and other illnesses."

A prolonged fight

Although initially passed by the state House a year ago, the bill was held up in the Senate committee on banking and insurance as other insurance-related issues were added to the bill.

The bill also met with opposition by the insurance lobby, which argued the autism mandate would cause premiums to rise, would be an added expense to small business owners, and was unnecessary because the state was already covering autism treatments.

Waeltermann said autism advocates feared the Senate committee, chaired by Sen. Don White, R-Indiana, would scuttle the autism language and prevent the measure from going before the full Senate for a vote.

Waeltermann credited a favorable report by the Pennsylvania Health Care Cost Containment Council -- particularly the estimate that the mandate would only cost policy holders an additional $1 per month -- with turning the tide and pushing White's committee to approve the bill.

Several legislators and autism advocates -- including O'Brien and state Rep. John Pallone, D-New Kensington -- initially protested the amended Senate version of the bill because they believed it omitted language that would ensure the behavioral therapies were covered.

Pallone said the House amended the bill to include the desired language and both chambers of the Legislature signed off on the final version.

"I think it's an important piece of legislation that's going to help a lot of families," said Pallone, who has an autistic nephew. "Those children have a huge, huge opportunity for success."

White could not be reached for comment Thursday, but his Chief of Staff Joe Pittman said the senator felt the final version was a good compromise that balanced the needs of the autism community with the interests of insurance companies and businesses.

Waeltermann welcomed the end of a prolonged fight.

Although her sons, now 8 and 10, won't benefit as much by coverage of treatments intended for younger children, she said the change could free up state money for adult programming.

"It's been a long and arduous process," she said. "Now I can relax a little bit."

Liz Hayes can be reached at lhayes@tribweb.com or 724-226-4680.