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Oregon Tells Health Insurance Companies: Autism Therapy Should Be Covered

OPB | Aug. 14, 2014 2:05 p.m. | Updated: Aug. 14, 2014 4:56 p.m. | Portland

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The Oregon Insurance Division announced Thursday that it will begin drafting language to clarify the responsibility of insurers to cover a specific autism therapy.  

The therapy, called Applied Behavioral Analysis, involves intense one-on-one work that many say helps children improve verbal and motor skills. 

But it’s expensive. A 20-hour-a-week regimen can cost $50,000 a year and many insurance companies have fought paying for it. 

But now a federal court in Oregon has found that Providence Health Plans violated both federal and state laws by denying coverage. 

In a press statement released Thursday, Oregon’s Insurance Commissioner, Laura Cali, said recent court decisions have brought clarity that coverage for the therapy should be required of all insurers. 

But her declaration does note that there are are limited circumstances in which denial of coverage may be reasonable.  “What we’re basically announcing is that we’re beginning work on a bulletin and so the purpose there is to clarify how the division is going to be interpreting the law and regulations that apply to this.”

She said the state will start a public process to gather input from consumers, advocates and insurance companies. But, she added, “really, what our aim is for putting out this bulletin, is that broad exclusion of coverage of ABA therapy for autism really aren’t going to be possible.”

On  OPB’s Think Out Loud, the father of two autistic children, Paul Terdal, was asked whether Cali’s announcement means his fight to get the therapy covered in Oregon, is over.  He said, “pretty much yeah. Actually she called me this morning to let me know she was going to do that, which I really appreciate. We have been working closely with them on this issue for several years and there had been conflicting legal opinions within the government and an extraordinary amount of pressure from the insurance industry not to do this. And about a year ago Commissioner Cali and I basically agreed that it made sense to wait for the court ruling before coming out with this.” 

Oregon Health & Science University has been fighting coverage of the therapy for its employees.  But it issued a statement Thursday saying the therapy will be a covered beginning 2015.

The Oregon Public Employees’ Benefit Board is also embroiled on a lawsuit over the issue.

PEBB interim administrator Kelly Ballas told OPB that she’s been advised by the Department of Justice not to comment on the issue because of that lawsuit.

Providence did not offer a comment.

 

 

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