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Editorial: Autism law requires remedy to meet original intention

Feb. 06, 2012 @ 11:18 PM

West Virginia's new law extending health care coverage to children with autism didn't turn out exactly as billed, and advocates for that new coverage are now seeking a fix.

We don't blame them. And we think the Legislature should make the sought-for change so that the intent of legislation promoted a year ago is not undermined.

The new law requires public and private insurance programs to cover treatment for the neurological disorders involved with those who suffer from autism. The focus of the effort behind the law was for insurers to provide coverage for applied behavioral analysis, a therapy that's considered crucial, particularly at an early age. Insurance previously had not covered ABA therapy in West Virginia, meaning parents had to pay out-of-pocket or let their children go without the treatment.

The legislation did set caps -- in clear language -- on the costs to insurers for applied behaviorial analysis, based on age. Those limits were up to $30,000 annually for the first three years and then $2,000 monthly until age 18. An analysis by the Public Employees Insurance Agency of the potential costs to its coverage plans clearly understood the caps to apply to the behavioral analysis only.

However, that changed as the legislation got to its final form before passage last March. The wording of the bill that was signed into law substituted "treatment" for "applied behavioral analysis."

For private insurers, the law went into effect Jan. 1, and they are taking the bill to mean that the cap applies to all treatment related to autism. That would include drugs as well as speech and other forms or therapy. The net result is that families will now reach the annual and monthly caps much more quickly and the amount of behavioral analysis paid for by insurers will be greatly reduced.

Backers of the legislation, including some of the bill's sponsors, must have failed to catch the change or at least not fully recognized the ramifications.

But it seems clear that insurance companies were aware. Fred Early, president of Highmark Blue Cross-Blue Shield West Virginia, say insurance companies are interpreting the bill accurately and are opposed to any effort to change the caps. He noted that the "cap mechanism portion of the legislation ... was carefully negotiated and passed last year." We wonder how many families advocating for the original legislation were involved in those negotiations and were aware that the language substitution was made.

We encourage lawmakers to take a close look at legislation to amend the new law, and pass a bill that will fulfill the intended impact of providing significantly more assistance to families who feel the weighty financial and emotional burdens of helping their children.

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