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Harbin bill would mandate autism coverage

Law would require insurers to pay for early intervention

Posted: February 11, 2013 - 10:12am  |  Updated: February 13, 2013 - 1:06am
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Melissa Solares plays a card game with her son, Arturo, 5. The Solares family paid out of pocket for intensive therapy for Arturo, who has autism.  Photo by Jim Blaylock
Photo by Jim Blaylock
Melissa Solares plays a card game with her son, Arturo, 5. The Solares family paid out of pocket for intensive therapy for Arturo, who has autism.

A bill filed this week by a Columbia County lawmaker would require insurance companies in Georgia to pay for early intervention care for children with autism.

Ava’s Law, named for a Lyons, Ga., girl with autism, is sponsored by state Rep. Ben Harbin, R-Evans. The legislation would mandate insurance companies pay for expensive, intensive services for children diagnosed with autism.

Currently, insurance companies in Georgia won’t pay for specialized therapy, including Applied Behavior Analysis, for children with autism. Parents must either accept the diagnosis and rely on special needs services from the public school system, or pay for therapy that can improve the child’s abilities at an estimated $30,000 to $50,000 per year.

“It’s devastating for parents to come up with that kind of money,” said Judith Ursitti, the regional director of state advocacy for Autism Speaks. The “window of early intervention” for children with autism makes it urgent that the therapy begin before about age 6; its duration, and total cost, depends on the severity of the autism, she added.

There’s little argument the therapy works, Harbin said. The problem is getting insurance companies to agree to pay for it.

“It is a mandate, and those get such a bad connotation,” Harbin said. “But insurance companies don’t provide autism coverage in this state. Other states do.”

Russell Childers Jr. of Americus, Ga., chairman of the Government Affairs Committee for the Georgia Association of Health Underwriters, said the professional organization wouldn’t favor such legislation.

“We don’t really have a position on the autism mandate,” Childers said. “We have a position on mandates in general.”

Federal health reforms are expected to further increase the cost of insurance coverage, he said, and the industry opposes mandates that could add to that expense.

Still, supporters of the legislation take hope from its passage in other states, including South Carolina. In 2007, the Legislature overrode then-Gov. Mark Sanford’s veto to enact Ryan’s Law, which mandates autism coverage.

Successful implementation of that law, along with similar legislation recently enacted in Texas, gives supporters of Ava’s Law reason to believe they’ll have more success than a 2009 attempt that failed in Georgia.

“I really do believe in this legislation,” said Melissa Solares of Evans. “We need help. You go five miles away (to South Carolina), and these children are getting the services they need.”

Solares and her husband paid out of pocket for intensive therapy for her son, Arturo, now 5, when their health insurance wouldn’t provide coverage after his diagnosis of autism.

As a toddler Arturo was non-verbal and not potty-trained, and seemed destined for a life of special education classes, Solares said.

Since the therapy, he’s now enrolled in a regular preschool. “We changed the path of his trajectory,” Solares said.

“I feel like my son’s life depends on this,” Solares said. “It’s important that these children in Georgia have a chance.”

An analysis of other state’s programs show that paying for the early intervention therapy would cost policyholders just 33 cents per month, Harbin said.

Changes ahead from the federal Affordable Care Act, however, make adding mandates a bad idea, Childers said.

“There are lots of reason we should have this coverage and that coverage on health insurance,” Childers said. “But we don’t feel like it makes sense to add things to the federal law before we see what the federal law is going to cover and how much it’s going to cost.”

While cost is a huge factor, Harbin contends that funding early care is a better option than warehousing autistic students in taxpayer-funded special education classes.

“If they’ll make this investment today, it’ll actually save them money down the road, and it’ll save taxpayers money down the road,” Harbin said. “It’s the right thing to do.”

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