Autism coverage bill could reduce benefits for state employees

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About 1 in 88 children in the U.S. has been diagnosed with an autism spectrum disorder, according to the Centers for Disease Control and Prevention.

It is now up to Kansas lawmakers to determine if insurance companies will be allowed to reduce the autism coverage for children they provide to state employees under the State Employee Health Plan, or SEHP. This includes K-State faculty and staff.

Autism is a neurological disorder that can impair communication and social behavior. Severe forms of the disorder can require people to have special care for a lifetime.

Cheryl Richt, instructor in music, said any reduction of coverage would personally affect her family.

“I have a son with autism and he is 14,” Richt said. “So under the new state employee health plan, he wouldn’t receive anything.”

The Kansas House of Representatives received two bills related to autism coverage, House Bills 2704 and 2531. HB 2704, sponsored by the insurance industry, limits autism coverage to 520 hours of treatment per year for children nine years old and younger. It would also limit coverage to large-group plans that cover 51 or more employees sold after Jan. 1, 2015.

Richt said the state’s plan helped her family pay for treatments that allowed her son to live at home.

“My son spent two years in a state facility in Kansas City,” Richt said. “So finally, he’s back home, we’re getting the help we need, and now they want to cut it. If he loses that therapy and that support, he won’t be able to stay at home any longer.”

HB 2531, co-sponsored by 35 representatives, would grant coverage of 2,080 hours of treatment a year and would apply to large-group, small-group and individual insurance plans grandfathered in after the Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act or “Obamacare.”

Provisions in the PPACA require states to pay for additional costs if something is added to state-regulated insurance plans after it was enacted, according to a story by the Kansas Health Institute.

Mary Beth Chambers, manager of corporate communications for Blue Cross and Blue Shield of Kansas, said HB 2531 would increase premiums for all policyholders because of what is in the bill.

“The fact that the bill has no annual dollar limits is a big concern for the insurance industry,” Chambers said. “As the costs go up, the premiums would go up and that would affect everyone.”

Chambers said insurance companies are working closely with legislators to come up with a resolution.

“Some of the elements are already in place,” Chambers said. “We just hope to resolve it in a manner that’s financially sound.”

H.B. 2531 would only marginally raise the price of premiums, according to Richt.

“The second year cost of this benefit, as reported by the [Kansas State Employees Health Care Commission] was 26 cents per month per member,” Richt said.

The CDC reported an increase in the number of children diagnosed with some form of autism, from 6.7 cases per 1,000 children in 2000 to 11.3 cases per 1,000 children in 2008. As the numbers rise, schools are expected to pay more to accommodate their needs, according to a report by the Harvard School of Public Health.

Helen Miller, autism coordinator for Manhattan-Ogden school district USD 383, said the district currently has about 150 students diagnosed with some form of autism.

“Every student has different needs, whether they fall into the autism spectrum or not,” Miller said. “We provide comprehensive educational support.”

That support includes resource teachers, added space in schools, after-school programs and assistance for preschool-age children. More than $10 million was spent across the district on special education during the 2012-2013 school year.

“Our students absolutely need these programs,” Miller said. “If we don’t do the services that kids need, they’re going to fall behind and that’s going to cost everyone.”

Richt said she was told a hearing on the issue will be held in the House on March 10.

“One of the two bills will be going to hearing,” Richt said. “We do not know which bill. It may truly depend on how many people call-in, are aware and voice their concerns or opinions. But we don’t know.”

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