Vitale-Weinberg Bill To Require Health Benefits Coverage For Autism Treatment Receives Final Legislative Approval

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 74-5, receiving final legislative approval.

“In New Jersey, autism spectrum disorders and developmental disabilities have reached epidemic proportions,” said Senator Vitale, D-Middlesex, and Chairman of the Senate Health, Human Services and Senior Citizens Committee. “While we move closer to understanding the causes for – and treatments of – autism every day, insurers have not lived up to their responsibility to make these new treatments accessible for struggling families. We need to make sure that the treatments which make a difference in the lives of autistic and developmentally-disabled individuals are within reach for those individuals who could reap the greatest benefit.”

“Insurance companies have a sacred duty to cover the health care needs of their subscribers, and given the staggering rate of incidence, autism spectrum disorders and developmental disabilities are a major health care need for New Jersey residents,” said Senator Weinberg, D-Bergen, and Vice Chairwoman of the Senate Health Committee. “On behalf of the individuals who will make developmental leaps and bounds with access to the appropriate level of care, and on behalf of their families who are doing everything they can to afford that care, we must demand that insurers cover autism treatment in the Garden State.”

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.

“Thanks to cutting edge medical research, we are discovering new therapies and treatments aimed at unlocking the developmental potential of autistic and developmentally disabled people,” said Senator Weinberg. “However, for all the progress we are making through medical research, insurance companies continue to maintain barriers between autistic individuals and the treatments that will help them achieve their potential. We must demand that insurance providers live up to the responsibilities they have to their subscribers, and cover those medically-proven treatments and therapies that can help make a difference.”

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.

“I think Assembly Speaker Joe Roberts and the other bill sponsors in both houses of the Legislature deserve a lot of credit for standing up for children with autism and their families,” said Senator Vitale. “Given the epidemic proportions of autism in New Jersey, we have to do a better job getting autistic individuals the treatment they need to meet their potential. Thanks to the advocacy of Speaker Roberts and others, we will get autistic kids access to promising new treatments and therapies which will have an impact on their quality of life moving forward.”

The bill now heads to the Governor to be signed into law.

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