Tagged: health insurance

Yesterday, the Michigan Legislature passed a series of autism coverage bills that will go to Governor Snyder.

It was one of the first significant pieces of legislation to move through the legislature with broad bi-partisan support.

The bill requires insurance companies to pay for autism spectrum disorder (ASD) diagnosis and treatment for children up to age 18.

Under the bill, insurance companies regulated by the state will have to cover expenses for ASD therapy and diagnosis...

• of up to $50,000 a year for kids younger than 7,
• $40,000 a year for kids ages 7-13,
• and $30,000 for kids up to age 18.

Questions about funding

The law will go into effect on October 1, but some questions have been raised about part of the funding for the mandated coverage.

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.

Michigan doctors say they are spending too much time writing prescriptions for their patients.

‘Prior authorization’ was intended to reduce the cost to insurance companies by having patients use generic drugs. But doctors say the process is bogged down in Michigan by 150 insurance companies each requiring doctors to fill out different forms.   

Stephen Newman is the president of the Michigan State Medical Society. He says doctors often spend half their time with a patient trying to wade through the ‘prior authorization’  process.

"That’s a waste of time, both for the patient as well as the physician,"  says Newman,  "And it leads to inefficiencies…that leads to emergency room visits that are unnecessary. 

The State Senate Insurance committee today approved legislation to streamline ‘prior authorization’ by requiring all insurance companies use the same form.      

Insurance industry representatives at the committee meeting were divided on the legislation.

LANSING, Mich. (AP) - The Michigan Senate soon could vote on bills aimed at requiring insurance companies to cover some types of treatment for autism.

The Senate's Health Policy Committee on Thursday approved a bipartisan package of bills related to autism coverage, sending the bills to the Senate floor. They go to the House if the Senate passes them.

One bill sets up a fund to help reimburse insurers for paid claims related to diagnosis and treatment of autism. That provision is included in hopes of lessening opposition from business and insurance groups.

Previous efforts to mandate autism coverage have stalled in Michigan.

More than half the states require insurers to provide autism coverage. Gov. Rick Snyder says it's time or Michigan to join them.

An Ottawa County Circuit Court judge is ordering Blue Cross Blue Shield to pay the City of Holland $1.6 million. Holland is one of dozens of communities that sued Blue Cross over variable fees charged on insurance claims filed by employees.  The city claims the insurer didn’t tell them about the fees for 17 years.

Blue Cross Blue Shield spokesperson Helen Stojic says the fees were not hidden.“As the lawsuit proceeds to the appellate courts we’re confident that the legal process will result in a finding that our access fee were known to our customers,” Stojic said.

A national advocacy group for autism-treatment says Michigan tops its list of states it believes could require insurance companies to cover treatments for autistic children this year.

Rick Remington, with the New York-based group Autism Speaks, said the support of Republican leaders in the Michigan legislature along with Governor Rick Snyder bodes well for autism-treatment legislation.

“It’s been before the legislature for a number of years, it’s gotten strong support from Governor Snyder, as well as the advocacy of the lieutenant governor,” Remington said. “We’ve got strong support, bi-partisan support from the Michigan legislature. So, we’re very confident we will see a bill become law this year.”

Twenty-nine states already have insurance mandates for autism-treatment.

Remington said advocates for autism coverage are becoming more prevalent in legislatures throughout the nation as the number of autism diagnoses increases.

Many insurance companies oppose the idea, saying it would increase costs.

A new state tax could be in jeopardy. Starting January 1, every time an insured patient sees a doctor and the claim is submitted to an insurance company for payment, one percent will be added to the bill. The money will help fund Michigan’s Medicaid program.

The Self-Insurance Institute of America is challenging the tax in federal court.

"This will essentially put in new administrative requirements for how health insurers administer health claims," said SIIA COO Michael Ferguson, who says that’s not allowed under federal law.

More than one hundred workers, union representatives and business lobbyists showed up at the state Capitol today to testify on proposed changes to Michigan’s workers compensation law.

The proposed changes before a state Senate panel would reduce an injured worker’s benefits based on the amount an insurance company believes the worker could be earning at another job.

Chris Luty, with the Michigan State Police Troopers Association, told lawmakers finding a job, especially while injured, is not as easy as some insurance companies would claim.

“What’s available out there – what’s really available out there – and what’s theoretically available out there are often two very different things,” said Luty.

Luty told lawmakers about a state trooper named Drew Spencer, who was hit by a car while on the job. Spencer’s injuries were severe and left him dependent on workers compensation benefits.

“Drew Spencer, like most people within the Department of State Police, has a lot of experience before he came in. He has an education. And when you apply the virtual wage language as I understand it, Drew Spencer would get nothing under this bill, as I understand it,” said Luty.

The proposed changes also includes extending the length of time an injured worker must see a doctor assigned to them by insurance companies rather than their own doctor.

Carl Alden, with the Michigan Association of Chiropractors, says letting injured workers visit their own doctors makes sure workers get the best medical care so they can get back to work more quickly.

“The success of Michigan’s current system shows that making a change is not in the best interest of employers, workers, Michigan, and ultimately the insurers,” said Alden.

Business groups say the proposed changes would help reduce fraudulent claims from workers and provide stability for businesses.

The Senate panel is expected to continue hearings on the workers comp issue when the Legislature returns from a two-week break next week.

Fewer than 100 unmarried state employees are expected to sign-up for health care benefits for their domestic partners by the end of this month.

That would mean less than $600,000 would be spent on live-in partner benefits paid for by the state.

The preliminary estimates are well below what some Republican lawmakers said taxpayers would end up paying for the benefits.

Republican state Representative Dave Agema (R-Ottawa Co.) sponsored a measure to end domestic partner benefits for public employees in the future.

"Numbers aside, it really doesn’t make any difference because what we have now, if it doesn’t stop, it will only grow in the future," said Agema. "We haven’t included the colleges and the local governments and so-forth, so it would only be increased to millions and millions of dollars in the future."

Agema’s proposal could not reverse the decision by the state Civil Service Commission to allow for public employee domestic partner benefits.