The Path to Meaningful Health Insurance Coverage in Maryland - PowerPoint PPT Presentation

The Path to Meaningful Health Insurance Coverage in Maryland

States with Autism Insurance Reform

State Autism Insurance Reform State Year State Annual Dollar Cap Age State Small Enacted Population Cap E’ees ? Group? Indiana 2001 6,484,000 None None Yes Yes South Carolina 2007 4,625,000 $50K 16 Yes No Texas 2007 25,146,000 None <10 No Yes Arizona 2008 6,392,000 $50K: 0-8, $25K: 9-16 16/17 Yes No Louisiana 2008 4,533,000 $36K <17 Yes Yes Florida 2008 18,801,000 $36K ($200K lifetime) <18 Yes No Pennsylvania 2008 12,702,000 $36K <21 Yes No Illinois* 2008 12,831,000 $36K <21 Yes Yes New Mexico* 2009 2,059,000 $36K ($200K lifetime) 19/22 No Yes Montana 2009 989,000 $50K: 0-8, $20K: 9-18 18 Yes Yes Nevada 2009 2,701,000 $36K 18/22 Yes Yes Colorado 2009 5,029,000 $34K: 0-8, $12K: 9-19 <20 Yes Yes Connecticut* 2009 3,574,000 $50K: 0-8, $35K: 9-12; $25K: 13-14 <15 Yes No Wisconsin 2009 5,687,000 $50K for 4 yrs, $25K after None Yes Yes New Jersey* 2009 8,792,000 $36K 21 Yes Yes judith.ursitti@autismspeaks.org 3

State Autism Insurance Reform State Year State Annual Dollar Cap Age State Small Enacted Population 1 Cap E’ees ? Group? Maine 2010 1,328,000 $36K <6 Yes Yes Kentucky 2010 4,339,000 $50K: 0-7, $1000/mo: 7-21 1-21 Yes Yes Kansas 2010 2,853,000 $36K: 0-7, $27K: 8-19 <19 Yes only No Iowa 2010 3,046,000 $36K <21 Yes only No Vermont 2010 626,000 None 1 ½ - 6 Yes Yes Missouri 2010 5,989,000 $40K 19 Yes Yes New Hampshire 2010 1,316,000 $36K: 0-12, $27K: 13-21 21 Yes Yes Massachusetts 2010 6,548,000 None None Yes Yes Arkansas 2011 2,916,000 $50K <18 Yes No West Virginia 2011 1,853,000 $30K for 3 yrs; $24K up to 18 3-18 Yes Yes Virginia 2011 8,001,000 $35K 2-6 Yes No Rhode Island 2011 1,053,000 $32K 15 Yes No New York 2011 19,378,000 $45K None Yes Yes California 2011 37,254,000 None None No Yes Michigan 2012 98,836,640 $50K if <7, $40K if 7-12, $30K if 13-18 18 Maybe Yes Alaska 2012 722,718 None 21 Yes >20 Delaware 2012 907,135 $36,000 21 Yes Yes 4 judith.ursitti@autismspeaks.org

Meanwhile in Maryland … 2011 2009 2010

Patience is a virtue Persistence gets the job done

A New Strategy in MD Get Leaderships’ Support We had TWO Major Barriers to address: • An inflated Fiscal Note • The NO NEW MANDATES mantra in Annapolis Autism Speaks Provided: • Claims data from other states to show that costs were considerably less than suggested by the insurance carriers • Insight as to what would be included in the Essential Health Benefits packages under the Affordable Care Act

Gain Leadership Support Speaker of the House Michael Busch Delegate Pete Hammen, Chair Heath & Government Operations Senate President Mike Miller Senator Mac Middleton, Chair Senate Finance

ROAD BLOCK In February 2012, States had to “take a picture” of all their existing mandates. Anything that was currently mandated had to be covered under the Health Care Exchange. In February 2012, MD did not have an Autism Insurance Mandate. If we did pass a mandate, it would be after the snapshot. Would the services be covered under the exchange? No one knew.

CREATIVE THINKING Speaker of the House Michael Busch Joshua M. Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene. Delegate Pete Hammen, Chair Health & Government Operations Delegate Ariana Kelly

ALTERNATE PLAN Secretary Scharfstein suggested that, given the political climate, we tie Autism Insurance Reform to the existing Habilitative Care Services Mandate. Using this approach gave us several advantages: • No Fiscal Note • No new Mandate • Services would be included in the Snapshot and therefore covered under the Health Care Exchange. Delegate Ariana Kelly agreed to sponsor the Bill

HB1055/SB744 HB1055/SB744, called for the creation of an Autism Technical Advisory Group (ATAG), composed of individuals with expertise in the treatment of autism spectrum disorders. The ATAG was charged with determining the medically necessary and appropriate use of habilitative care services for the treatment of autism. Bill passed and in Fall 2012 the ATAG was appointed by Secretary Sharfstein April 2013 - ATAG presented their recommendations to Secretary Sharfstein.

ATAG Recommendations The ATAG developed separate recommendations for children 18 months through age 5 and age 6 through age 19 • Children diagnosed with an ASD from 18 months of age through their 5th birthday should receive 25 hours per week of comprehensive, individualized habilitative services that address social interactions, communication and language, and maladaptive behaviors. • Children age 6 through their 19th birthday should receive 10 hours per week of habilitative services beyond those received during the school day.

Scope of Services Comprehensive habilitative services should be evidence-based and should include, but are not limited to: 1. Behavioral health treatment, which refers to counseling and treatment programs, including applied behavior analysis , that are; a. necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual; and b. provided by a Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCABC), supervised by a BCBA or by a licensed psychologist so long as the services performed are commensurate with the psychologist’s university training and supervised experience. 2. Psychological care, which refers to direct or consultative services provided by a psychologist or social worker licensed in the state in which the psychologist or social worker practices. 3. Therapeutic care, which refers to services provided by licensed or certified speech therapists, occupational therapists, or physical therapists

NEXT STEPS Regulations to be Published Public comment period Reviewed by the Joint Committee on Administrative, Executive, and Legislative Review The regulations shall be adopted by the Insurance Commissioner on or before November 1, 2013.

Thanks to Senator Kathy Klausmeier For being a long time supporter of the Autism community and for providing insight and advice on strategic direction

judith.ursitti@autismspeaks.org 17

Missouri Department of Insurance Analysis of All Covered Plans 2011 • Implemented Jan 2011 • Terms • $40,000/yr (cap only applies to ABA)* • until age 18* • Total claims paid = $4,309,828 • Total covered lives = 17,332,763 • Unique claimants = 3,805 • PMPM cost Year 1 = 25 ¢ * Caps can be exceeded if deemed medically necessary Source: Missouri Department of Insurance, Financial Institutions and Professional Registration

Missouri Department of Insurance Analysis of All Covered Plans 2012 • Implemented Jan 2011 • Terms • $40,000/yr (cap only applies to ABA)* • until age 18* • Total claims paid = $6,555,602 • Total covered lives** = 17,429,153 • Unique claimants = 2,508 • PMPM cost Year 38 ¢ Source: Missouri Department of Insurance, Financial Institutions and Professional Registration, 2012 19

Effect on Premiums • Claims incurred for treatment of ASD represent 0.1% of total claims • “ While claims costs are expected to grow somewhat in the future, it seems very unlikely that costs for autism treatment will have an appreciable impact on insurance premiums .”

Average Second Year Cost of Autism Insurance Reform State Employee Health Plan Data State estimated lifetime cost savings of providing appropriate treatment are $1 million per child (Jacobsen et al, 1998) Source: Data collected from State agencies responsible for administering State Employee Health Benefits Programs 21

• What type of health insurance do I have? • Is it regulated by the state or by the federal government? • If it is regulated by the state, which state regulates it? • How will federal healthcare reform impact all of this?

Self- Funded “ERISA” Plans That Cover ABA • Stanford University • University of Minnesota • Progressive Group • IBM • Greenville Hospital System • • Symantec Arnold & Porter • • DTE Energy Eli Lilly • • Cerner Southern Baptist Convention • • State Street Financial Ohio State University • • Children’s Mercy Blackbaud • • EMC Lahey Clinic • • Sisters of Mercy Partners Healthcare • • Princeton University Wells Fargo • • Pinnacle Casinos Capitol One • • And many more . . . White Castle judith.ursitti@autismspeaks.org