Insured Children’s Autism Treatment Guarantee Advances Under the Leadership of Sen. Charlie Bethel

ATLANTA (January 26, 2015)  |  Senate Bill 1 received a unanimous “do pass” recommendation from the Senate Insurance and Labor Committee today and will advance to the Senate Rules committee for calendar consideration. Sen. Charlie Bethel (R – Dalton) provided an overview of SB 1 during a press conference earlier in the day announcing the 2015 legislative priorities of the Senate Majority Caucus. The proposed legislation seeks new guidelines for the coverage of Autism Spectrum Disorders (ASD) in children up to six years old, including diagnostics and medically necessary treatments or therapies. Sen. Bethel is the primary sponsor of the legislation, which is also fully supported by the Senate Majority Caucus.

“As a parent, I can’t think of anything more devastating than being told my child faces severe challenges for which proven treatments exist, but are unavailable. The Georgians I know would do everything in their power to make sure their child, or any child, has the ability to receive medical care that will give them the best opportunity to lead a full, productive and normal life. This sentiment isn’t unique among Georgia parents; especially those who are struggling to provide an autistic child with access to early intervention and behavioral therapies,” said Sen. Bethel

The Autism and Developmental Disabilities Monitoring Network, a program supported by the Centers for Disease Control and Prevention, estimates 1 in 68 children are diagnosed with autism each year. This ratio is higher than childhood diabetes, cancer and AIDS combined.

SB 1 includes several insurance guidelines for the diagnosis and treatment of autism in children age six and under, including:

  • The coverage of any professional assessments, evaluations, or tests necessary to diagnose ASD
  • The coverage of ASD treatment if deemed medically necessary by a physician or psychologist
  • An unspecified number of necessary doctor or specialized care visits
  • A provision limiting coverage to $35,000 annually for Applied Behavioral Analysis (ABA) treatments
  • A provision that does not require prescription drug coverage for ASD treatment if drug coverage is not already provided by the policy or contract

“The clear majority of our sister states facing this same dilemma have elected to include some sort of guarantee to insured children and their families. It’s time for us to look past the historical framework of this discussion and see a much bigger issue—and that’s the financial and emotional burden autism places on Georgia families and ultimately, on Georgia’s economy,” said Sen. Bethel.

To ensure fiscal responsibility, insurers who can prove the above provisions would trigger at least a 1% rate hike for all policies, or that the cost of ABA treatments exceeds 1% of the premiums, would be exempt from providing coverage for one year.

The coverage requirements outlined in SB 1 do not apply to small businesses with less than 10 employees. Because federal law has preempted the field, there is also no requirement in SB 1 for insurance plans offered through the health exchange or employer funded plans to provide coverage.

Georgia will become the 36th state to require some form of autism insurance coverage if SB 1 receives final approval by the General Assembly and the Governor.

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For Immediate Release:
January 26, 2015

For Information Contact:

Jennifer Yarber, Director