Item 2.  CHILDREN WITH SPECIAL NEEDS

POLICY RECOMMENDATION: The 2008 Children's Agenda supports legislation to require private insurance coverage of expenses associated with treatment of autism spectrum disorders that are prescribed by the treating physician in accordance with an individual treatment plan.

Provide Insurance Coverage for Autism

DEFINITION
Autism is a complex neurobiological disorder that typically appears during the first three years of life and affects the normal functioning of the brain, impairing a person's ability to communicate and relate to others.  It is also associated with rigid routines and repetitive behaviors.  Symptoms can range from very mild to quite severe.

PREVALENCE
Autism is the fastest-growing serious developmental disability in the U.S.  The Centers for Disease Control and Prevention estimates that one in 150 children is diagnosed with autism, making it more common than pediatric cancer, diabetes and AIDS combined.  In Oklahoma, more that 2,025 children between the ages of 3 and 21 diagnosed with autism spectrum disorder are enrolled in Special Education in our public schools.  This presents a 60% increase in just three years.

MEDICAL RESPONSE
There is currently no known cure for autism, yet with early detection and intervention, many of the symptoms related to autism can be greatly improved and allow children to enter school and lead productive lives.

The American Academy of Pediatrics has just released new guidelines urging primary care providers to conduct developmental screenings, as early intervention is critical in order to gain maximum benefit from therapies.  Early, intensive, structured behavioral therapies, such as Applied Behavior Analysis (ABA), have proven effective in helping children suffering with autism spectrum disorders to gain intellectual functioning and progress educationally.

PROBLEM
Most private health insurance plans do not provide coverage for the diagnosis and treatment of autism spectrum disorders, leaving many parents to rely on government sponsored services.  In fact, most insurance companies designate autism as a diagnostic exclusion, meaning that any services rendered explicitly for the treatment of autism are not covered by the plan, even if those services would be covered if used to treat a different condition.  Parents who are denied coverage often end up paying for therapies out of their own pockets creating an immense financial burden.  Without the negotiating powers of an insurance company behind them, parents can often spend $50,000 per year on services.

The Council for Affordable Health Insurance reports in "Health Insurance Mandates in the States 2007," that 10 states currently require private health insurers to provide autism benefits.  The premium increases associated with these mandates are modest, ranging from 0.44 per contract per month to $4.10 per contract per month.  In South Carolina, with its $50,000 maximum yearly benefit for behavioral therapy, the projection is a $4.00 per contract per month, or an increase of about $50 per year.

Fact Sheet:
Provide Insurance Coverage for Autism