Questions About Costs, Duration of New Autism Mandate Persist in Calif.

Questions remain about the costs and permanence of an autism treatment mandate that Gov. Jerry Brown (D) has signed into law, the San Francisco Chronicle reports.

The governor alluded to the concerns in his signing message of the measure.

Brown wrote, "There are remaining questions about effectiveness, duration and the cost of the covered treatments that must be sorted out," concluding, "There is still much work to be done" (Colliver, San Francisco Chronicle, 10/12).

Background

On Sunday, Brown signed into law a bill (SB 946), by Senate President Pro Tempore Darrell Steinberg (D-Sacramento), that requires insurers to cover beginning in July 2012 an autism treatment for children called applied behavioral analysis.

The mandate will last until 2014, when the provision could be included as an essential health benefit under the federal health reform law.

The mandate does not apply to Medi-Cal, California's Medicaid program, or Healthy Families, California's Children's Health Insurance Program. Some critics of the measure said it discriminates against children who are not covered by private health plans.

Meanwhile, insurance companies have argued that the autism treatment is an educational therapy and not a medical treatment (California Healthline, 10/11).

Cost Concerns

The California Association of Health Plans contends that the new law will increase health care costs by nearly $850 million annually.

The therapy ranges in price from $36,000 to $75,000 per year for each patient.

Questions About Duration of Coverage

If the therapy is not included as an essential health benefit under the reform law, it will either no longer be required or the state will need to decide whether to continue the coverage mandate.

Parents of children with autism said that even if the federal government does not include the coverage as an essential health benefit, the state should maintain it.

Jerry Flanagan, a staff attorney for Consumer Watchdog, said that the state would have to pay for any additional coverage it mandates above what is required by federal law (San Francisco Chronicle, 10/12).

Columnist Supports Autism Treatment Mandate

Los Angeles Times columnist David Lazarus writes that health insurance companies "have long argued that behavioral therapy ... is not medical treatment" and have worried "about the slippery slope of having to cover other behavioral therapies, such as group homes for people with schizophrenia."

The California Association of Health Plans also has raised concerns "that the new mandate for coverage will cause premiums to increase for individuals and employers," Lazarus notes.

However, "the bottom line is how we, as a society, address the health care needs of those less fortunate than ourselves," he adds, concluding, "If nothing else, the government has an obligation to step in when the private sector, out of a sense of financial self-preservation and fiduciary obligations to shareholders, evades a responsibility to provide coverage to all" (Lazarus, Los Angeles Times, 10/11).