State legislation: Vermont - Insurance coverage for ABA for early intervention restored to S. 262; bill reported as passed by the legislature and on the way to the Governor

On Friday, May 7, 2010 Autism Votes reported that the Vermont Senate concurred with the passed House version of,

S. 262  “An act relating to insurance coverage for autism diagnosis and treatment”, reverted to original title upon passage from AN ACT RELATING TO A STUDY OF COVERAGE OF APPROPRIATE SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

With this concurrence, S. 262 has passed the legislative hurdle and the next step is approval by Vermont Governor Jim Douglas .

S. 262 as introduced called for health insurance coverage of autism spectrum disorders. The Senate on March 23, 2010 passed a modified version which excised the insurance clauses in favor of creating a study committee. On consideration in the Vermont House, the House Committee on on Health Care and Wellness restored language specifying insurance coverage for a covered age range of 18 months to 6 years of age or entry to first grade, whichever is earlier. This amended version would also extend coverage to state employees. With some additional amendment,  this House version was approved by the Vermont House on Thursday, May 6, 2010.

Some language of interest relating to behavior analysis and behavior analysts (readers are advised to read entire text for full and definitive language),

Sec. 2. 8 V.S.A. § 4088i is added to read:

§ 4088i. COVERAGE FOR DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDERS

(a) A health insurance plan shall provide coverage for the diagnosis and
treatment of autism spectrum disorders, including applied behavior analysis
supervised by a nationally board-certified behavior analyst, for children,
beginning at 18 months of age and continuing until the child reaches age six or
enters the first grade, whichever occurs first.
(...)
(d) As used in this section:
(1) “Applied behavior analysis” means the design, implementation, and
evaluation of environmental modifications using behavioral stimuli and
consequences to produce socially significant improvement in human behavior.
The term includes the use of direct observation, measurement, and functional
analysis of the relationship between environment and behavior.

(2) “Autism services provider” means any licensed or certified person
providing treatment of autism spectrum disorders.
(...)
(5) “Habilitative care” or “rehabilitative care” means professional
counseling, guidance, services, and treatment programs, including applied
behavior analysis and other behavioral health treatments, in which the covered
individual makes clear, measurable progress, as determined by an autism
services provider, toward attaining goals the provider has identified.

(6) “Health insurance plan” means Medicaid, the Vermont health access
plan, and any other public health care assistance program, any individual or
group health insurance policy, any hospital or medical service corporation or
health maintenance organization subscriber contract, or any other health
benefit plan offered, issued, or renewed for any person in this state by a health
insurer, as defined in 18 V.S.A. § 9402. The term does not include benefit
plans providing coverage for specific diseases or other limited benefit
coverage.

Sec. 3. APPLICABILITY AND EFFECTIVE DATE

(a) Sec. 2 of this act shall take effect on July 1, 2011, and shall apply to all
health insurance plans on and after July 1, 2011, on such date as a health
insurer offers, issues, or renews the health insurance plan, but in no event later than July 1, 2012.

(b) This section and Secs. 1 and 4 of this act shall take effect upon passage.

Sec. 4. EVALUATION OF COVERAGE FOR SCHOOL-AGE CHILDREN; IDENTIFICATION OF SAVINGS AND EFFICIENCIES

(a) The agencies of administration and of human services and the
department of education shall evaluate the feasibility and budget impacts of
requiring health insurance plans, including Medicaid and the Vermont health
access plan, to provide coverage of autism spectrum disorders, including
applied behavior analysis supervised by a nationally board-certified behavior analyst for children under the age of 18 who have been diagnosed with an autism spectrum disorder. The agencies and department shall also assess the
availability of providers of services across Vermont for individuals with autism
spectrum disorders. No later than January 15, 2011, the agencies and
department shall report their findings and recommendations regarding
expanding coverage of treatment for autism spectrum disorders to school-age
children and the availability of providers to the house committees on health
care and on appropriations and the senate committees on health and welfare
and on appropriations.
(...)
(d) If the report required by subsection (c) of this section or the findings of
the committees of jurisdiction indicate that sufficient funds will not be
available to offset the state’s share of expenditures related to the coverage
requirement established in Sec. 2 of this act in fiscal year 2012, it is the intent of the general assembly to consider whether to proceed with implementation of such coverage requirement.

For further reading
Autism Votes Vermont


pp. 2901-2905 Senate Calendar, Friday May 7, 2010
(Text of amended S. 262 considered by the Senate on May 7, 2010).

VT House Considers Bill Mandating Better Insurance Coverage for Autistic Children
Local Matters
By Andy Bromage [05.05.10]

Unfinished and disputed bills may stall Legislature's adjournment
Louis Porter and Peter Hirschfeld Vermont Press Bureau - Published: May 7, 2010

Report to the Legislature to Address Services for Individuals with Autism Spectrum Disorders
January 2008
Recommendation for specification of competencies of behavior analysis service providers referenced on page 23 , and insurance coverage referenced on pages 1,5,31, 32, 34 -34

Past blog post
Tuesday, March 23, 2010
State legislation Quicktake: Vermont autism insurance bill as amended passes state Senate, sent to the House

© 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.