Autism Speaks has endorsed a new bill, SP.127, which would amend Maine's 2010 autism insurance reform law by raising the age of eligibilty for benefits from 5 to 21. The measure is sponsored by Sen. Colleen Lachowicz (D-Kennebec).
The current Maine law took effect in 2011 and requires state-regulated health plans to cover the diagnosis and treatment of autism through age 5. The coverage includes speech, occupational and physical therapy, as well as behavioral health treatment, such as ABA, up to $36,000 per year.
Maine was the 16th of the current 32 states to enact autism insurance reform and is one of five states seeking to expand coverage this year.Senator Lachowicz testified for the bill:
Often families will get secondary MaineCare/Medicaid to cover ABA services, because they arethe only payor in the state that pays for this program past age 5. Then they can get the caretheir child needs from a qualified professional. An educated consumer wants to make sure theirchild receives treatment that is evidence-based from a well trained, qualified provider. In theend, the taxpayers wind up paying for something that parents want to provide for their familiesthemselves when they buy insurance. The State of Maine can save money on Medicaid bypassing this legislation
In 2010, the 124th Legislature passed a bill that said that insurance companies have to pay for autism services for children covered under health insurance plans up to the age of 5. The original bill specified the age of 21 but was amended in committee. This bill proposes again that insurance companies pay for services up until the age of 21. I looked at the previous legislation.One of the arguments was that once children are in school, they can access services for autism in school.
Well, I've worked in school-based behavioral health for a long time. I have to tell you that sometimes that isn't enough. If a child is having difficulty at home or in the community, the parent may need to access that professional someplace other than the school. The training level of the providers also varies greatly across school districts. School-based providers are not required to be trained in Applied Behavior Analysis, nor should they be; it is a specialty.Clinicians pick up generalist skills in working with a variety of conditions over time, but nothing replaces an evidence-based practice like ABA.