CHARLESTON, W.Va. -- West Virginia's 2011 law requiring insurance coverage for autism includes cost-containment language that should resolve concerns over a proposed legislative fix of the law, Senate President Jeff Kessler said Tuesday.
The executive director of the Public Employees Insurance Agency, Ted Cheatham, agreed with Kessler's assessment as the pending bill approaches a Senate vote Thursday.
The bill would make clear that benefit caps in the new law are meant for applied behavioral analysis. Experts consider ABA treatment crucial for many children diagnosed with autism spectrum disorders. This diagnosis applies to neurological conditions marked by impaired thinking, feeling, speaking and the ability to relate to others. Usually first diagnosed in early childhood, the spectrum of conditions includes a severe form called autistic disorder and the much milder Asperger's syndrome.
"We know that ABA is the treatment most effective for our kids," said Jill Scarbro-McLaury, a nationally certified ABA analyst who supports clarifying the caps.
The law limits benefits to $30,000 annually for the first three years-children can be diagnosed as early as 18 months-and then at $2,000 monthly until age 18. But the wording of the law when it passed the Legislature last year applied the caps to all autism-related treatment. Insurers have sought to keep it that way this session.
"The position that I have taken all along is, the change in language was more than just a cleanup," Cheatham said of the pending bill.
The bill would also correct errors undetected in the 2011 legislation that could create confusion and make it difficult to implement it. PEIA issued a financial analysis Tuesday estimating that the bill would increase its costs by at least $3.1 million annually. That's on top of costs of at least $11.3 million annually estimated by the agency when it analyzed last year's legislation.
"We just needed a fiscal note so the Legislature knows that if they go forward, there is going to be an impact," Cheatham said of Tuesday's estimate.
But Kessler noted Tuesday that the 2011 law already allows insurers to pursue additional cost-cutting measures, if the required coverage increases annual plan costs by at least 1 percent. That should forego the need for additional changes to the pending bill, the Marshall County Democrat said. Cheatham agreed.
"We are fine with Sen. Kessler's assessment," Cheatham said.
The coverage requirement applies to group policies issued or renewed as of Jan. 1. PEIA will begin offering coverage July 1, when its plan year starts. The new law exempts plans for employers with no more than 25 workers.
One in every 110 children in the U.S. has autism, the Centers for Disease Control and Prevention estimates. The National Institute of Mental Health considers it more common among children than diabetes, spina bifida, or Down syndrome. At least 23 other states mandate insurance coverage, though most cap benefits. The Council for Affordable Health Care, an industry research group, estimates that the resulting costs from these mandates increase premiums by between 1 and 3 percent.