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Got Insurance? The New Autism Insurance Law – aka ARICA

Learn how Massachusetts passed the strongest autism insurance bill in the country, providing coverage for necessary treatments for individuals with autism.

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Got Insurance? The New Autism Insurance Law – aka ARICA

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  1. Got Insurance?The New Autism Insurance Law – aka ARICA Amy Weinstock, Nan Leonard, JD, EdS, MHA, BCBA Insurance Committee, Advocates for Autism of MA (AFAM) Judith Ursitti, Director, State Advocacy Relations, Autism Speaks

  2. How Massachusetts Passed the Strongest Autism Insurance Bill in the Country Representative L’Italien, Senator Berry, Autism Speaks, and the AFAM Insurance Committee • “Leaders are visionaries with a poorly developed sense of fear and no concept of the odds against them” – Dr. Robert Jarvik • Several independent efforts to expand insurance coverage all came together.

  3. ARICA – Legislative Process • Bill was filed in January, 2009. Over 110 Legislators signed as Co-Sponsors. • ARICA was assigned to the Financial Services Committee, which held hearings in October 2009. • The State performs a Mandated Benefits Analysis of the Policy and Financial Implications of ARICA http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/10/mb_autism.pdf

  4. March 2010 - Mandated Benefits Analysis Highlights • Autism treatments are medically necessary and have strong evidence to support efficacy. • Cost impact is modest – a fraction of a percent on premiums. Approximately $1.84 Per Member Per Month (PMPM) –we noted that it was “less than a cup of coffee”. • Executive Summary: • Annual medical care cost estimates should be considered in the context of potential societal savings outside the medical care system, including those realized in education, social security payments and workplace productivity.

  5. Spring/Summer 2010 • June 15, 2010: H 3809 Assigned to House Ways and Means Committee • Massive grassroots calling and e-mailing efforts. • Families visit state house with cookies and PECS strips, t shirts

  6. ARICA Advocacy Day at the State House – July 21, 2010

  7. July 27, 2010: House passes UNANIMOUSLY July 29, 2010: Senate passes UNANIMOUSLY Delivered to Governor Patrick’s Desk, July 29 at 4:42PM

  8. Fenway Signing Ceremony

  9. Governor Signs Autism Insurance August 3, 2010

  10. Implementation • ARICA went into effect January 1, 2011. Implementation is based on each policy’s specific renewal date. • Only affects certain types of policies. • Private insurers • State employees and retirees • Hospital service plans • HMO’s

  11. Who Isn’t Covered? • “Self-funded” plans, sometimes called “ERISA Plans” are regulated by Federal Law and not required to comply with State Mandates. • Includes many of the State’s largest employers. • Some ERISA employers may, as a matter of course, comply with ARICA. • Outreach efforts are being planned for companies that need more information or are deciding not to cover autism treatment. • MassHealth and CommonHealth are not included in ARICA.

  12. What Treatments are Covered? • ARICA covers the following care prescribed, or ordered by a licensed physician or a licensed psychologist who determines the care to be medically necessary: • habilitative or rehabilitative care; • pharmacy care; • psychiatric care; • psychological care; • and therapeutic care

  13. How does this affect IFSP’s, IEP’s and ISP’s? • From Mass General Laws, Chapter 207 of the Acts of 2010: “This section shall not affect an obligation to provide services to an individual under an individualized family service plan, an individualized education program or an individualized service plan. Services related to autism spectrum disorder provided by school personnel under an individualized education program are not subject to reimbursement under this section.” • Under IDEA, schools may not require parents to access private insurance for services that are part of FAPE.

  14. Current Events • The Division of Insurance (DOI) held a series of meetings this Fall, with stakeholders - Consumers, Providers, Insurers, and others, to clarify specific details. • DOI issued an advisory and bulletin in December http://www.mass.gov/Eoca/docs/advisories/health_insurance_autism.pdf • http://www.mass.gov/?pageID=ocamodulechunk&L=4&L0=Home&L1=Government&L2=Our+Agencies+and+Divisions&L3=Division+of+Insurance&sid=Eoca&b=terminalcontent&f=doi_Bulletins_bulletins_10_15&csid=Eoca

  15. For Further Information • Information and updates on ARICA www.afamaction.org • Information on ARICA and Autism Legislation throughout the country www.autismvotes.org • Contact Information: • amyweinstock@verizon.net • nleonard11@aol.com • Judith.Ursitti@autismspeaks.org

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