Provider and public demand for individuals with ASD receiving and having insurance coverage for physical, occupational and speech therapy is reflected in public hearing testimony for House Bill 5696 and its
unanimous bipartisan approval during the 2008 legislative session. The Connecticut State Medical Society and an occupational therapist testified in support of the bill. The Connecticut State Medical Society supported the bill based on “the need to provide medically necessary treatments to those who need it most, and not excluding anyone because of ‘pre-existing conditions.’”351 Further support came from the Office
of Health Care Access, parents,352 educators, social workers and members of the advocacy organizations
Autism Speaks and Stamford Education4Autism. The OHCA considered the bill “a reasonable attempt to ensure coverage of therapies medically necessary for those with autism;” while parents and other providers noted that the bill could “provide relief to working families” and end insurer policies to “exclude people with known autism from coverage.”353
347 Kuhlthau K, Hill K, Fluet C et al. 2008. Correlates of therapy use and expenditures in children in the United States. Developmental
Neurorehabilitation 11(2): 115-23.
348 American Occupational Therapy Association. Autism Fact Sheet. Available at:
http://www.aota.org/Practitioners/Resources/Docs/FactSheets/Children/38517.aspx. Accessed September 27, 2010.
349 American Speech-Hearing-Learning Association. Autism: benefits of speech-language pathology services.
Available at: http://www.asha.org/public/speech/disorders/autismSLPbenefits.htm. Accessed September 27, 2010.
350 American Physical Therapy Association. Treating Kids with Autism. Available at:
http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/cm/htmldisplay.cfm&CONTENTID=53380. Accessed September 27, 2010.
351 Insurance and Real Estate Committee. Join Favorable Report HB-5696. March 25, 2008.
Available at: http://cga.ct.gov/2008/JFR/H/2008HB-05696-R00INS-JFR.htm. Accessed September 27, 2010.
352 Knall, S. Autism Speaks. Testimony to the Connecticut General Assembly. Available at:
http://www.cga.ct.gov/KID/Autism/testimony/Shannon%20Knall%20%20Autism%20Speaks.pdf. Accessed September 27, 2010.
353 Insurance and Real Estate Committee. Join Favorable Report HB-5696. March 25, 2008. Available at:
Testimonies in support of a more comprehensive bill raised in 2009, included 21 families each sharing about the “struggle trying to manage their child’s illness medically and financially.” 354 During this same hearing,
the Connecticut Medical Society testified that “this bill addresses an issue regarding medical necessity. Insurance companies need to provide comprehensive coverage for autism spectrum disorders, and currently they have been unwilling to handle the routine costs of medically necessary treatments claiming that these individuals had ‘pre-existing conditions’ or any other exclusion, making this bill a necessity for families dealing with autism.355
8. The likelihood of achieving the objectives of meeting a consumer need as evidenced by the experience of other states.
According to the National Conference of State Legislatures (NCSL), 35 states and the District of Columbia “have laws related to autism and insurance coverage.”356 At least 23 states (Arizona, Colorado, Connecticut,
Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, Vermont and Wisconsin) specify that insurers must provide coverage for the treatment of autism while the remaining states may require limited coverage for autism under mental health coverage, parity or other laws.357 Similar to Connecticut,
16 states specify that insurers cover ST, OT and PT or rehabilitative/habilitative services as treatments for ASD (The states with these mandates include Colorado, Florida, Illinois, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Texas, and Vermont).358-359
Among the states requiring insurers to provide coverage for the treatment of autism, specifications of coverage vary in terms of maximum benefits, age of eligibility and services covered.
9. The relevant findings of state agencies or other appropriate public organizations relating to the social impact of the mandated health benefit.
A number of states (Colorado, Maryland, Massachusetts, New Jersey, Virginia and Wisconsin), have published either prospective or retrospective mandated benefit reviews regarding the financial cost of the respective state mandate. However, no state agency or public organization reports on the social impact of ASD-related health insurance mandates were identified. States searched included those with a mandated benefit review requirement and those with an ASD-related health insurance mandate.
10. The alternatives to meeting the identified need, including but not limited to, other treatments, methods or procedures.
The background section provides an overview of approaches to minimize or manage symptoms and comorbidities related to ASDs. Since the manifestations of ASDs vary in breadth and severity across the diagnosed population, treatment is tailored to the individual’s specific needs. The ASD conditions most frequently treated include development of speech or language, the ability to carry out activities of daily living, social skills, motor skills and coordination. ST, OT, and PT therapy are the respective fields for 354 Ibid.
355 Ibid.
356 National Conference of State Legislatures. Insurance coverage for autism. Available at: http://www.ncsl.org/?tabid=18246. Accessed
September 27, 2010.
357 Ibid.
358 Kaminski JL. Insurance coverage for autism. December 27, 2006. OLR Research Report. 2006-R-0793.
Available at: http://www.cga.ct.gov/2006/rpt/2006-R-0793.htm. Accessed September 27, 2010.
359 National Conference of State Legislatures. Insurance coverage for autism.
Volume II. Chapter 6
addressing many common ASD concerns.
Additional approaches are also used. For example, applied behavior analysis (ABA) has been used to help facilitate skill development while diet modifications or nutrition supplements are recommended by some to address intolerances or imbalances. However, ABA, diet modifications, and other approaches are not considered substitutes but rather complementary to needed speech, occupational or physical therapy.
11. Whether the benefit is a medical or broader social need and whether it is consistent with the role