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Saturday, January 26, 2013

Mandate Problems

Putting a mandate in place is a beginning, not a conclusion.  Problems crop up, as several examples illustrate.

The issue comes down to differences between a law and the regulations to implement it, and the differences between certification and licensing.
The law signed by Gov. Andrew Cuomo in 2011 requires insurers to pay up to $45,000 a year for autism services that include a form of extended therapy called applied behavior analysis. That therapy breaks complex skills into small steps to improve skills and address concerns related to eating, feeding sleeping, toileting and challenging behaviors.
New York's law said that the therapy must be provided by or at least supervised by a certified behavior analyst. New York has roughly 750 board certified behavior analysts. The regulation requiring licensing cuts the pool of eligible supervisors to 43. [emphasis added]
The state Department of Financial Services, which oversees the insurance and banking industries, has not yet responded to a request for comment.
During the 2011-12 election cycle, the insurance  industry made $404,150 in campaign contributions to Cuomo, who appointed the head of the department. Judith Ursitti, Director of State Government Affairs for Autism Speaks, says that industry lobbying may have swayed the regulatory decision.
“The reason I say that is because we’ve passed autism insurance laws in other states, and once we pass the law and begin working on implementation , this particular roadblock seems to be popping up. We’ve had similar situations in Rhode Island and Virginia where we have worked through the process and resolved it.”
Autism service providers are encouraging families of children with autism to write the Department of Financial Services’ Superintendent, Ben Lawsky, to encourage him to “implement the law as it was intended” [emphasis added]
 In Michigan, MLive reports:
Michigan’s new program allowing health insurance companies to be reimbursed for paid claims related to autism coverage is off to a slow start.
The reimbursement provision for carriers and third-party administrators was part of a compromise that helped the autism coverage plan win approval in the Michigan Legislature and be signed into law last year. The law mandates that insurance companies provide coverage for autism treatment and diagnosis. The reimbursement is designed to help companies offset those costs.
The state’s autism coverage fund is allocated $15 million for the current fiscal year that began in October -- but only two claims had been submitted and paid out to insurance companies as of this week, according to the state’s Department of Licensing and Regulatory Affairs. The total claims paid were a little more than $3,000 combined.
In Ohio, The Toledo Blade reports on a contention that actions by Governor John Kasich may violate the state constitution.
The Ohio Health Care Freedom Amendment was overwhelmingly supported by voters in 2011 and was largely seen at the time as a message to the federal government opposing President Obama’s health-care law. But the amendment also prohibits Ohio from mandating specific types of coverage, according to Maurice Thompson, executive director of the 1851 Center for Constitutional Law.
The last legislative session ended last month without final passage of a bill that had bipartisan support to require health policies issued in the state to include coverage for autism, a broad category of disorders affecting child brain development. The disorders can affect communication, attention, and behavior, among other things.
When the bill did not pass, in part because of opposition from business, Mr. Kasich ordered such coverage to be included in state policies for 39,000 government employees. He also sent the Obama Administration a written “comment” on proposed federal rules for implementation of the new Patient Protection and Affordable Care Act in Ohio that his office said have the effect of including autism spectrum disorder as part of the minimum coverage private insurers would have to provide under the law.
The governor’s action may not have technically violated the language of Ohio’s 21st right under its constitution’s Bill of Rights, but it violates the spirit of the amendment, Mr. Thompson said.
“We want to litigate that if we can,” Mr. Thompson said. “We’d like to get the autism mandate off the books because it can be highly destructive to the health-care market and small business. It precludes freedom of choice and violates the spirit of the health-care amendment.”