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Vitale-Weinberg Bill To Require Health Benefits Coverage For Autism Treatment Advances In Committee

TRENTON – A bill sponsored by Senators Joseph F. Vitale and Loretta Weinberg which would require health insurers in New Jersey to provide coverage for screening for autism and other developmental disabilities as well as any medically-necessary occupational, physical and speech therapy, was unanimously approved by the Senate Health, Human Services and Senior Citizens Committee today.

“Autism spectrum disorders and developmental disabilities can cause an enormous strain, not just on the child affected, but on the parents looking to provide every opportunity for their autistic son or daughter,” said Senator Vitale, D-Middlesex, and Chairman of the Senate Health Committee. “Behavioral intervention can mean the difference between a lifetime of communications and learning difficulties, and the possibility of overcoming many of the difficulties associated with autism and other developmental disabilities. Health insurers have a responsibility to give kids access to the sort of treatments and therapies which can make a major difference in their lives.”

“I don’t know of any parent who wouldn’t do everything in their power to give their autistic or developmentally-disabled child every chance to excel,” said Senator Weinberg, D-Bergen, and Vice Chairwoman of the Health panel. “However, the enormous cost of behavioral intervention – despite the miracles its working in the lives of autistic individuals – sometimes makes it out of the realm of possibility for many families. By requiring insurers to cover behavioral intervention, we can give autistic and developmentally disabled kids a more level field from which to learn and grow into productive adults.”

The bill, S-1651, would require that insurers in New Jersey would be required to provide insurance coverage for diagnostic and therapeutic services designed to identify and treat autism and other developmental disabilities. Under the bill, insurance companies would be required to provide up to $36,000 per year in coverage for medically necessary behavioral early intervention for all autistic patients under 21 years old. Beginning January 1, 2012, the Department of Banking and Insurance would adjust the maximum benefit to reflect inflation according to the consumer price index.

“Early diagnosis and aggressive and ongoing behavioral therapy is showing so much promise in mitigating the effects of autism and other disorders on affected kids,” said Senator Weinberg. “However, right now, parents can only access such promising treatments by paying the high cost of behavioral intervention out-of-pocket. These therapies are absolutely the sort of thing that should be paid for through health insurance, and insurers need to step up and meet their responsibility to their insurance subscribers.”

The sponsors noted that research has demonstrated that early intervention services, which include speech, physical and occupational therapy, help the majority of young children with autism and other developmental disabilities to learn important skills. Additionally, numerous studies have shown that early treatment of autism spectrum disorders through behavioral intervention such as applied behavioral analysis may serve to mitigate many of the problems and challenges associated with the disorder.

Currently, ten states nationwide have enacted some form of legislation requiring insurance coverage of autism treatment. Most have some form of cap on expenses paid out by insurers – ranging from $36,000 to $50,000 – and most cap the age limit at which insurers must cover treatment – ranging from 6 years old to 21 years old.

“We’re not proposing a massive mandate on health insurers here, but rather, a benefit which is in line with other states that require coverage for behavioral intervention,” said Senator Vitale. “The economic impact analysis we’ve seen shows that this burden won’t be too difficult on insurers, but will mean so much in giving autistic and developmentally disabled children the tools and therapies they need to excel. This bill is humane and responsible, and will help so many families battling the specter of autism every day.”

The bill now heads to the Senate Budget and Appropriations Committee for review, before going to the full Senate for consideration. The bill was also approved by the Assembly Appropriations Committee today, and is scheduled for a full vote in the Assembly on Thursday, May 21.

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