Michigan legislature poised to pass autism treatment bill

Mar 29, 2012

The state House has approved a measure that will require insurance companies to cover autism treatments for children. The state Senate is expected to concur with the House action later today and send the bill to Governor Rick Snyder's desk.

Senate bills 414, 415, and 981 would require the following, according to the House Fiscal Agency:

  • Require group and individual health plans to cover services for autism spectrum disorders (ASD) in a manner similar to physical illnesses.
  • Allow health plans to limit coverage for ASD treatment to a yearly maximum based on age, and limit coverage to children 17 years of age and younger.
  • Allow insurers to request, among other things, a review of ASD treatment.
  • Provide a limited exemption for qualified health plans offered under the federal Patient Protection and Affordable Care Act.
  • Create the Autism Coverage Incentive Act and the Autism Coverage Fund.
  • Establish the Autism Coverage Incentive Program, under which insurance carriers could seek reimbursement from the Fund for expenses incurred in providing coverage for ASD.

The House Fiscal Agency writes:

The Governor's FY 2012-13 Executive Budget Recommendation for the Department of Community Health includes an increase of $34.1 million Gross ($10.1 million GF/GP) to fund autism spectrum disorder treatment for the Medicaid and MIChild eligible children under the age of six.

The report indicates that approximately 2,000 kids under the age of six would meet the criteria that would be established with the new policy. 2,000 kids with an "average expenditure of $17,000 per child."

The Autism Coverage Incentive Program is expected to cost the state between $500,000 to $1 million to administer.