Autism Insurance Breakthroughs Called Into Question

Recent reports from Disability Scoop confirm the old adage, “If something seems too good to be true, it probably is." In early July, California officials announced deals with Anthem Blue Cross and Blue Shield of California under which the insurers said they would provide coverage for applied behavioral analysis (ABA) therapy for individuals with autism.

Sounds like a fantastic breakthrough until you read the fine print. The ABA must be administered by a state-licensed provider and to date, California has no mechanism for even licensing ABA therapists. Outraged advocates from the Alliance of California Autism Organizations, Consumer Watchdog and other groups charge that the requirements “will lead to delays, interruptions and continued denials of treatment.” It could take up to two years for a licensing system to be established, two years in which children with autism languish without treatment.

As autism advocates press for ABA coverage nationwide, the issue of who licenses therapy providers is emerging as the flashpoint of dispute. Lawmakers in Virginia recently approved legislation requiring insurance coverage for ABA starting in 2012, but a last minute amendment by the governor added that same proviso that the ABA therapist must be licensed by the state. Again, no state licensing agency exists, so the reality is that the 2012 start date for coverage is a cruel joke. Further requirements of pre-authorization and independent evaluation of services slow down delivery of services even more.

Even if a fast-tracking clause was added to the Virginia law to speed up the creation of the state regulatory agency, only 10 objections are needed to thwart the effort. The unsurprising opponents include the National Federation of Independent Business, Independent Insurance Agents of Virginia, the Virginia Chamber of Commerce and the Virginia Association of Health Plans. All have balked at the potential costs. A spokesman for the insurance lobby pointed out that insurance companies are free to cover ABA if they wish, yet realistically none will without a mandate to do so.

The Behavior Analyst Certification Board was established in 1998 as a national entity and set rigorous standards for certification of ABA therapists. An international association of behavioral therapist also exists. Adding another laying of bureaucracy at the state level seems designed to forestall needed coverage while still appearing responsive to the crisis of autism.