Presentation on theme: "Amy Weinstock, Nan Leonard, JD, EdS, MHA, BCBA Insurance Committee, Advocates for Autism of MA (AFAM) Judith Ursitti, Director, State Advocacy Relations,"— Presentation transcript:
Amy Weinstock, Nan Leonard, JD, EdS, MHA, BCBA Insurance Committee, Advocates for Autism of MA (AFAM) Judith Ursitti, Director, State Advocacy Relations, Autism Speaks
Representative L’Italien, Senator Berry, Autism Speaks, and the AFAM Insurance Committee “Leaders are visionaries with a poorly developed sense of fear and no concept of the odds against them” – Dr. Robert Jarvik Several independent efforts to expand insurance coverage all came together.
Bill was filed in January, Over 110 Legislators signed as Co-Sponsors. ARICA was assigned to the Financial Services Committee, which held hearings in October The State performs a Mandated Benefits Analysis of the Policy and Financial Implications of ARICA
Autism treatments are medically necessary and have strong evidence to support efficacy. Cost impact is modest – a fraction of a percent on premiums. Approximately $1.84 Per Member Per Month (PMPM) –we noted that it was “less than a cup of coffee”. Executive Summary: ◦ Annual medical care cost estimates should be considered in the context of potential societal savings outside the medical care system, including those realized in education, social security payments and workplace productivity.
June 15, 2010: H 3809 Assigned to House Ways and Means Committee Massive grassroots calling and ing efforts. Families visit state house with cookies and PECS strips, t shirts
Delivered to Governor Patrick’s Desk, July 29 at 4:42PM
ARICA went into effect January 1, Implementation is based on each policy’s specific renewal date. Only affects certain types of policies. ◦ Private insurers ◦ State employees and retirees ◦ Hospital service plans ◦ HMO’s
“Self-funded” plans, sometimes called “ERISA Plans” are regulated by Federal Law and not required to comply with State Mandates. Includes many of the State’s largest employers. Some ERISA employers may, as a matter of course, comply with ARICA. Outreach efforts are being planned for companies that need more information or are deciding not to cover autism treatment. MassHealth and CommonHealth are not included in ARICA.
ARICA covers the following care prescribed, or ordered by a licensed physician or a licensed psychologist who determines the care to be medically necessary: habilitative or rehabilitative care; pharmacy care; psychiatric care; psychological care; and therapeutic care
From Mass General Laws, Chapter 207 of the Acts of 2010: “This section shall not affect an obligation to provide services to an individual under an individualized family service plan, an individualized education program or an individualized service plan. Services related to autism spectrum disorder provided by school personnel under an individualized education program are not subject to reimbursement under this section.” Under IDEA, schools may not require parents to access private insurance for services that are part of FAPE.
The Division of Insurance (DOI) held a series of meetings this Fall, with stakeholders - Consumers, Providers, Insurers, and others, to clarify specific details. DOI issued an advisory and bulletin in December th_insurance_autism.pdf th_insurance_autism.pdf &L=4&L0=Home&L1=Government&L2=Our+Age ncies+and+Divisions&L3=Division+of+Insurance &sid=Eoca&b=terminalcontent&f=doi_Bulletins_b ulletins_10_15&csid=Eoca &L=4&L0=Home&L1=Government&L2=Our+Age ncies+and+Divisions&L3=Division+of+Insurance &sid=Eoca&b=terminalcontent&f=doi_Bulletins_b ulletins_10_15&csid=Eoca
Information and updates on ARICA Information on ARICA and Autism Legislation throughout the country Contact Information: ◦ ◦ ◦