FYI: Self-funded Health Insurance Plans and ERISA

With the state legislature sessions opening soon and the likelihood of insurance reform legislation submissions, it seems timely to point out information on reimbursement (and limitations) under self-funded health insurance Plans, and to make note either as an advocate or potential beneficiary of legislation as to the language of a bill (or law) in regards to the matter of self-funded policies.

As noted by Autismvotes, in its webpage, Information for Families With Self-Funded Health Insurance Plans

"Even in the states that have passed autism insurance reform , many children are still unable to receive treatment because they are insured through self-funded plans that are not regulated by the state.  If you work for a large company or government, there is a chance your health plan is a self-funded insurance plan.  For self-funded insurance plans, federal ERISA [Employee Retirement Income Security Act of 1974 (ERISA)] law preempts most state insurance regulations, including benefit reforms like autism insurance reform..."

Some of the useful resources at Autismvotes are,

• Self-funded plans: Establishing an autism benefit
• How Private Health Insurance Works: A Primer
• Companies with self-insured health plans that have opted to provide coverage for autism therapies

The Association of Professional Behavior Analysts (APBA) also recently published an article on self-insured entities, with pointers on which self-insured companies provide ABA coverage in their policies,

Self-Insured Employers Cover ABA Intervention for Autism and Other Special Needs
Laurie Stuebing, APBA Autism Task Force
APBA Reporter Issue # 3 - February, 2009.

One other useful reference is from the State of Colorado, Division of Insurance - this has some Colorado-specific clauses, but in general is a clear, lay-friendly explanation of ERISA, self-funded plans, and information on departments in the Federal Government dealing with this area.

ERISA -- Employer-sponsored Self-funded Health Benefit Plans
Colorado Division of Insurance January 2009

• What is ERISA?
• What is the difference between a health insurance plan and an employer-funded health benefit plan
• (ERISA)?
• What steps can I take if I am covered under an ERISA plan and my claim is denied?
• Who has regulatory authority for ERISA plans?
• What are required procedures for Employee Welfare Benefit Plans (Self-funded Plans)?
• What is the “summary plan description” and how does it work?
• Do states have the authority to regulate Employer-sponsored Self-funded Health Benefit Plans?
• How many people in Colorado are insured under an employer-sponsored or self-funded health benefit plan (ERISA plan)?
• Who can provide more information on Employer-Funded Health Benefit Plans?

This post originally posted
Tuesday, December 22, 2009
FYI: Self-funded Health Insurance Plans and ERISA
Practitioner Issues in Behavior Analysis SIG blog

© 2010 Regina G. Claypool-Frey

Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.

Evidence-based practice: NAC National Standards Project announces new manual - "Evidence-Based Practice and Autism in the Schools"

The National Standards Project of the National Autism Center announced in their December newsletter that a NEW manual targeting educators is available for free download or purchase at their website, and shared an update on the also available recently released National Standards Project Report.

National Autism Center Releases New Autism Educator Manual

"We are pleased to make available a comprehensive new manual by the National Autism Center entitled, Evidence-Based Practice and Autism in the Schools.

'We created this manual for educators as a means of promoting evidence-based practice for Autism Spectrum Disorders (ASD) in schools,' said Susan M. Wilczynski, Ph.D., BCBA, Executive Director of the National Autism Center. 'We know that research-supported interventions are most likely to produce positive outcomes for the ever-increasing numbers of students with ASD.'

The development and publication of the manuals were made possible through support from the American Legion Child Welfare Foundation, Inc., and the Niel M. Wreidt 2003 Revocable Trust. The American Legion grant enabled us to distribute the first 3,000 manuals free of charge to public school systems throughout the country.

Due to the overwhelming response to the manuals, we are making them available on our website. Visitors can now download them for free, or purchase a hard copy through our on-line Bookstore. We welcome you to take a look!"

This new manual is a complement to the National Standards Project Report, previously issued in September, which addressed the level of evidence for autism interventions.

NAC Director Susan M. Wilczynski, Ph.D., BCBA talks about the National Standards Project

In their update on the National Standards Project Report, the NAC December newsletter also stated that,

"The response to our September announcement of National Standards Project results has been tremendous! Individuals from every state in the United States, and from close to 50 countries, have visited our website in the past two months. They have downloaded tens of thousands of free copies of the Project results.

Help us to continue spreading the word! Forward our e-card to others who might be interested in learning about the National Standards Project.

We invite you to visit our website to view and download a free electronic copy, or to purchase a printed copy, of the report.

The primary goal of the National Standards Project is to provide critical information about which treatments have been shown to be effective for individuals with Autism Spectrum Disorders. The National Standards Report covers a broad range of applied treatments and identifies the level of scientific evidence available for each. The report serves as a single, authoritative source of guidance for parents, caregivers, educators, and service providers as they make informed treatment decisions. We are confident that these findings and recommendations will change lives and give hope and direction to people whose lives are touched by autism."

2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.