Insurance reforms make way for autism coverage in 2016

ST. GEORGE – Before April, 34 states required insurance providers to cover autism treatment. With a stroke of Gov. Gary Herbert’s pen on April 2, Utah become the 35th state to enact autism insurance reform.

The Autism Services Amendments legislation, better known during the recent legislative session as Senate Bill 57, requires many state-regulated insurance providers to cover behavioral health treatments, along with speech, occupational, physical therapy, and physiological and psychiatric care for children ages 2 through 9.

Nationally, autism spectrum disorder affects every one in 68 children. According to the Center for Disease Control, the autism rate in Utah is every one in 54 children – the highest in the country.

SB 57 was sponsored by state Sen. Brian Shiozawa, R-Salt Lake City, and Rep. Brad Dee, R-Ogden.

Autism advocacy group Autism Speaks praised the passage of the new legislation.

“Autism Speaks commends Senator Brian Shiozawa for his leadership in delivering for the Utah autism community,” said Mike Wasmer, Autism Speaks’ associate director of state government affairs, in a press release. “The Utah Autism Coalition has fought hard to make this day happen and we were proud to be their partner.”

Prior to SB 57, attempts to pass similar legislation in 2009, 2012, and 2013 each failed.

While the new legislation requires many insurance providers to cover autism treatments as a part of their policies starting Jan. 1, 2016, it also allows a way some companies may bow out of the mandate if necessary.

An insurance provider may seek a waiver from the state if that provider can show that adding autism coverage has caused a 1 percent or more increase in premiums. The provider may also be able to bow out if implementation of the autism treatment coverage somehow causes them to come into conflict with federal regulations.

Under the new legislation, insurance providers can request status reviews of the autism treatment every six months.

The bill passed the Utah House March 12 in a 69-3 vote, with three representatives not voting or absent. Southern Utah Reps. V. Lowry Snow, Michael Noel, John Westwood, Brad Last, and Don Ipson all voted for the bill. Rep. Jon Stanard did not vote.

The bill passed in the state Senate March 13 in a 24-1 vote, with four senators either absent or not voting. Southern Utah Sens. Evan Vickers, Steve Urquhart, and Dived Hinkins voted in favor of the bill. Sen. Ralph Okerlund did not vote or was absent.

The Autism Services Amendments legislation was one of over 350 new laws passed by the Utah Legislature during its 2014 session.


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Copyright St. George News, LLC, 2014, all rights reserved.


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