Thompson Foundation for Autism

The bill includes coverage for applied behavior analysis (ABA) for children with autism spectrum disorders (ASD) up to $40,000 per year, or more if medically necessary, through age 18. Insurance coverage for non-ABA therapies is not subject to age limits or monetary caps. Insurers cannot impose visit limits on any coverage under the bill, other than the dollar cap on ABA.

Passage of the autism insurance bill is the culmination of years of legislative efforts and lengthy discussions over the last four months.  Board members of the Thompson Foundation for Autism worked closely with autism organizations from across the state of Missouri as well as state legislators to seek passage of this bill.

Its primary sponsor in the Missouri Senate was Senator Scott T. Rupp, R – St. Charles; co-sponsor Eric Schmitt, R – Glendale, who has a son with autism. Rupp said autism is the only disorder out of the top 10 childhood neurobiological disorders that is not covered by health insurance. Senator Schmitt added, “ Children on the autism spectrum deal with so many challengers each and every day. These proven therapies are the difference between whether a family can go to a restaurant without having to leave early, the difference between a child having meaningful friendships. We owe it to these families to give their children the opportunity to reach their full potential. Put simply, this bill is the right thing to do and the right time to do it.”

Lead sponsors of the bill in the House were Reps. Dwight Scharnhorst, R – St. Louis, Jason Grill, D – Kansas City, and Jeff Grisamore, R – Lee’s Summit/ Greenwood. Representative Steve Tilley,R – Perryville, also was instrumental in the passage of the bill.

“ For families like ours, the skies have opened, “ said Rep. Dwight Scharnhorst, a St. Louis County Republican whose grandson was autistic and who has championed the legislation for years. “ A lot of families aren’t receiving this kind of treatment – they can’t afford it. But now they’re on the road to improving that child’s life. “

The bill will go into effect on January 1, 2011.

A Recap of the Bill

• $40K cap on ABA until age 18

• No cap on other therapies
• Definition of therapy includes equipment (communication devices and other assistive technology will be covered)
• Triennial COLA (every 3 years the cost of living allowance on the cap can be adjusted)
• Treatment plans are subject to 6 month review (not 3 month review as in earlier versions)
• Annual reporting is required of insurers on specific parameters
• Autism is defined using language that refers to the “current version of the DSM” (the dated DSM IV language was removed)
• State licensure (which requires BCBA certification) is required for behavior analysts, but front line therapists (implementers) will not have to register

The Missouri Autism Coalition believes provisional licensure for behavior analysts will be required between 2011-2012. Licensure will then be required beginning Jan 1, 2012.

The licensure for behavior analysis constitutes a “practice act”, which means that the language essentially defines the practice of ABA in Missouri. It does NOT mean that you only have to have a license if you are billing insurance for ABA.  Therefore it applies to anyone who is practicing behavior analysis (with an exemption for public school staff implementing IDEA and 504 Plans, and students doing ABA practicums).

For more information, go to www.missouriautismcoalition.com or  www.autismvotes.org/Missouri