Morgantown, WV - In 2011, West Virginia became the 25th state in the nation to require insurance coverage for children diagnosed with autism. The bill was revised during the past legislative session and became effective on June 9, 2012.
The autism bill’s lead sponsor, Delegate Barbara Evans Fleischauer, D-Monongalia, warned that there are challenges ahead. “The fact that our bill is now law is cause for celebration,” she said. “However, based on what we have seen in other states, parents wanting to access benefits may face difficulties.”
Under the new law, parents must obtain a diagnosis of autism by a psychologist or physician and an order stating that applied behavioral analysis therapy is medically necessary. Applied behavioral analysis therapy is the only evidenced-based therapy that has been proven to treat autism.
If treatment is approved for insurance, parents may obtain up to $30,000 per year for treatment for three years following the date of diagnosis, which can be as early as 18 months. Thereafter, benefits of up to $24,000 annually may be available until the child reaches age 18.
Early treatment is essential for children affected by autism. Over 90 percent of those who receive early treatment make significant improvements and half of those can improve to the point of no longer fitting the diagnosis. Until now, families have had to pay out of pocket for these evidence-based treatments, but with the new legislation, some or all of the costs could be covered by insurance.
“We are expecting some confusion,” said WVU Professor Dr. Susannah Poe. “There are exceptions to coverage, billing codes have not yet been assigned, and we do not yet have a sufficient number of certified providers.”
Fortunately, help is on the way. TRAIN (Training and Resources for Autism Insurance Navigation in WV) is a new statewide collaborative program. Dr. Poe, working with the Mountaineer Autism Project (MAP) and the WVU Center for Excellence in Disabilities, applied for and received a Benedum grant to fund a resource center for families whose children have been diagnosed with autism.
TRAIN has scheduled a round table meeting of WV Autism Insurance Stakeholders for July 13, 2012 at Stonewall Jackson Resort. Invited to attend are insurance providers, legislators and representatives of CHIP and PEIA. “We hope to mark a path for families to follow to gain the treatment the law mandates,” explained Dr. Poe.
For more information, families can visit the MAP website, mountaineerautismproject.org or contact Dr. Poe, at WVU’s Klingberg Neurodevelopmental Center, 304-293-7331.