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Vitale-Weinberg Bill To Require Health Benefits Coverage For Autism Treatment Approved In Assembly

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 approved by the Assembly today by a vote of 71-4, with one abstention.

“With one of the highest rates of prevalence in the entire country, autism spectrum disorders have reached epidemic proportions in the Garden State,” said Senator Vitale, D-Middlesex, and Chairman of the Senate Health, Human Services and Senior Citizens Committee. “New Jersey must take the initiative to make sure children with autism spectrum disorders and developmental disabilities have access to the treatment and therapies which can make a difference in their lives. This bill is about holding health insurers to their obligation of providing coverage for medically-necessary treatments, including those that may hold promise for children living with autism.”

“Not only is autism hard on children struggling to communicate to the outside world, but it can be torture for the parents looking to understand the disease and get their kids help,” said Senator Weinberg, D-Bergen, and Vice Chairwoman of the Senate Health Committee. “I don’t know of a single parent who wouldn’t give everything they’ve got to give their child a chance to excel, but in the case of autism spectrum disorders and developmental disabilities, the most-productive treatments can be expensive and ongoing. Health insurers must live up to their responsibility to give children the tools and treatment they need to achieve their maximum developmental potential.”

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.

“Every day, we’re making breakthroughs in the treatments and therapies designed to help people with autism spectrum disorders and their families,” said Senator Weinberg. “However, if the high cost of care puts these treatments out of reach for the folks who can receive the greatest benefit, then the advances will do little to actually combat the rising numbers of autistic and developmentally disabled children in New Jersey. Health insurance providers must do the responsible thing and include medically-necessary, evidence-based treatment for autism under the umbrella of coverage.”

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 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.

“The benefits we’re proposing are not astronomical for insurance companies, but will mean the world to families scraping the bottom of the barrel to afford care for their autistic and developmentally disabled kids,” said Senator Vitale. “Early and comprehensive intervention services can bring about miracles in the lives of autistic children, allowing them to overcome some of the communications and learning difficulties that are part of the disease. Health insurers have a duty to give kids access to these services, particularly when so many studies indicate that early intervention represents an autistic child’s best hope of overcoming the disease.”

The bill is still pending consideration by the Senate Budget and Appropriations Committee, before going to the full Senate for a vote. It was approved by the Senate Health Committee and the Assembly Appropriations Committee on Monday.

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