Utah Bill Would Require Coverage for Autism Treatment

Welcome to UtahUtah is one of the states that does not require private health insurance companies to cover the cost of treatment for autism. That could change, thanks to a new bill that would require private health plans to cover it. This is in response to pilot programs that failed to provide adequate coverage.

Right now, there are 32 states that require all health insurance plans to cover the cost of autism treatment. Typically, this means that the insurance plan will cover applied behavioral analysis, (ABA). It is an ongoing form of treatment that can require 25 to 40 hours a week. When health insurers deny coverage for autism treatment, it places the burden of paying for it onto the families.

In Utah, there is a bill called SB55. It was released by Senator Brian Shiozawa, a Republican from Cottonwood Heights. Autism Speaks, a national advocacy group, endorsed the bill. If the bill gets passed into law, it would require private health insurance companies in Utah to cover autism therapy.

More specifically, the bill (if made into law) would require private insurance plans to cover the diagnosis and treatment of autism. This would include coverage for occupational therapy, physical therapy, and applied behavior analysis (ABA).

Insurers would have to cover up to $50,000 a year for children who have autism and are under the age of 9. It would also require insurers to cover up to $25,000 a year for children who have autism and who are between the ages of 9 and 18. The coverage would start as of July 1, 2013.

This bill is more than likely in response to the pilot programs in Utah that were intended to cover the cost of autism treatment for children, (but failed to adequately do so). The state’s current plan covers 315 children who are between the ages of 2 and 6.

Children who had autism and were covered by Medicaid had to take part in a lottery system in order to, potentially, be selected for treatment. According to the Salt Lake Tribune, the Medicaid program has yet to start treating children.

Clearly, this bill would provide much needed treatment for children who have autism. Nationwide, there are 1 in 88 children who have autism. In Utah, that number is 1 in 47. Before parents start celebrating, please realize that there are some potential issues that could prevent the bill from taking affect.

As with any bill, there is the potential that it will not make it through the process involved in becoming a law. If this happens, there are two possible outcomes. The bill could, one day, be proposed again. Or, the bill could be “done”, and never be brought up again.

If bill SB55 becomes law, be aware that it does not require absolutely all types of health insurance to cover autism treatment. Companies that are self-insured would not be affected by the law.

Small employers can seek a waiver from the requirement to cover autism treatment in employee health plans. To get this waiver, they company would have to prove that the cost of coverage increased their premiums by at least 2.5% in a year.

Image by Phil Whitehouse on Flickr