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What is at stake in the Autism insurance bill?

Updated Mar 06, 2019; Posted Mar 21, 2017

Rep. Jim Patterson, R-Meridianville, introducing his bill to provide insurance coverage for children with autism. (Trisha Crain /

By Ashlie Walker,a board certified behavior analyst and Birmingham native. She is the owner of Milestones Behavior Group, Inc., which specializes in integrity-based training on behavior analytic strategies in school settings and applied behavior analysis therapy for children with Autism in their Vestavia Hills clinic.

About HB284

Alabama is one of only five states left in the country without insurance reform to mandate the coverage of evidence-based Autism therapies. HB284 is the best shot at meaningful Autism insurance reform this state has ever seen.

In his Yellowhammer article, Bill Canary, head of the Business Council of Alabama, claims that cost of this legislation is "unknown" or "being hidden." However, verifiable, fiscal data across 45 other states have shown the cost of Applied Behavioral Analysis (ABA) coverage does not exceed 50 cents per member per month and these numbers were provided by Autism Speaks at the HB284 hearing. The Business Council is refusing to acknowledge verified data on the costs in other states.

Canary claims that Alabama's state government provides health insurance coverage to more than 400,000 public education employees and government workers and retirees, and it currently chooses not to cover all available autism therapies due to the high costs. In the meantime, law makers and their constituents expect teachers to provide a free and appropriate public education of quality to their children; failing to acknowledge that many educators have children with Autism and can't afford the fully recommended amount of therapy based on their teacher salaries. The financial burden of covering these services is already placed on our Alabama schools as they are the primary funding source of ABA therapy at this time.

Canary states that Medicaid is supposed to cover these therapies for their participants, but they elect not to due to the high costs. The fight has begun to enforce the 2014 mandate for Medicaid to cover ABA for children ages 0-21.

Canary claims that The "Riley Ward Act" passed in 2012 requires insurers to offer Autism treatment, not mandate coverage, to large group customers. Based on a survey conducted by the Alabama Autism Society, NOT ONE child in Alabama has benefitted from this law to date.

Canary claims that ABA costs approximately $100 per hour and that children with Autism require 40 hours of treatment each week to produce desired results. That equates to more than $200,000 a year. However, not all children with Autism require 40 hours per week of ABA. it is standard practice in ABA to use a tier delivery model that utilizes the services of Registered Behavior Technicians whose hourly is around $30 per hour or Board Certified Assistant Behavior Analyst's whose rate is often half of the supervising Board Certified Behavior Analyst's.

Canary pokes fun at ABA calling it the "Cadillac of Autism Treatment." ABA is the only scientifically validated treatment for Autism. Half a century of empirical studies demonstrates the effectiveness of ABA for Autism across the lifespan and is endorsed by the US Surgeon General, American Academy of Pediatrics and The CDC.

Canary says that there are no state-licensed or regulated ABA therapists operating in Alabama and this "health tax" would be imposed for a service that cannot be provided. The Alabama Behavior Analyst Licensing Board became law in 2014 and will begin issuing licenses in May, 2017. There are 181 Board Certified Behavior Analysts in Alabama and many states with insurance reform do not require BCBA's to become licensed by a state regulated board as they are already regulated by the Nation Behavior Analyst Certification Board.

Canary claims that no hard numbers or rough estimates have been provided on how many individuals in Alabama would qualify for these therapies. BCBS-AL has the most useful and accurate data on file to determine this number. A simple search of claims with the "299.0" diagnosis code would yield these data. The CDC has not conducted a survey of the prevalence of ASDs in several years but they have historically recognized Alabama as having one of the lowest identified populations of Autism in the country.

The Autism community urges the members of the insurance committee to call a vote on HB284.

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