Bill to expand autism coverage fails in ND Senate

March 22--A bill requiring North Dakota insurance providers to expand coverage for autism services was rejected Tuesday by the state Senate.

The main provision of HB 1434, which was brought to the capital largely through the efforts of a network of parents of autistic children, would have required insurers in the state to provide coverage for applied behavioral analysis, a widely used therapy method for individuals on the autism spectrum which is not currently included under most North Dakota health insurance policies. The state is one of five without legal requirements for ABA insurance coverage.

Senators voted 16-31 to defeat the proposal after debating the merits of using legislation to mandate coverage that some described as limited or incomplete. The bill was approved by the House last month with a 61-29 vote tally after initially failing to pass by one vote.

Sandy Smith, executive director of the Fargo-based North Dakota Autism Center and an advocate of the proposal, said "hundreds of family members" had been working for the bill's passage.

"We're feeling a little low today," she said after the Senate vote.

Blues statement

After passing in the House, the proposal had been amended to reflect state requirements that new mandates be tested in the North Dakota Public Employees Retirement System for two years before being applied to the general insurance market. Many of those who spoke in opposition to the proposal referenced statements made by Blue Cross Blue Shield North Dakota, the largest insurer in the state, indicating the provider would begin offering ABA coverage on Jan. 1.

Sen. Judy Lee, R-West Fargo, and chair of the Senate Human Services Committee, testified against the bill, stating it "includes many challenges that would delay the coverage of some autism services."

"Even though some would be covered by the mandate, there are thousands of people who are covered by different health policies than those affected by this bill who would not receive the intended benefits," Lee said.

She characterized the bill as containing language that was "very restrictive" as to which autism service providers are eligible for insurance reimbursement and said the proposal lacked an accountability mechanism, as patient care plan reviews would not have been required. The bill allowed for such reviews to be conducted on an annual basis but did not necessitate them.

Sen. Tom Campbell, R-Grafton, spoke in favor of the proposal, citing the support of families of autistic children who "realize it is not perfect" but continue to stand behind it.

"They're part of a vulnerable minority who feel they're denied coverage for a legitimate claim," Campbell said.

He added the families who had brought the bill forward weren't sure what to make of the Blue Cross announcement of impending coverage, as there was "nothing in writing" guaranteeing such services would be extended.

"Most would rather have a study for PERS for two years than possibly nothing," he said, adding parents would rather "wait and get it right" than end up empty-handed.

"In 45 states so far, nobody has ever covered ABA therapy before a mandate was passed," Campbell testified.

Sticking point

The prospect of a mandate was a major sticking point for Sen. Nicole Poolman, R-Bismarck, who rejected the bill outright.

"Sometimes very good intentions get wrapped up in very bad bills," she said. "We, the government, are going into a private business and forcing them to sell a specific product and sell it only in the way we deem appropriate. Anyone who considers themselves a proponent of private enterprise or the free market should be adamantly against this bill."

Besides the mandate element, Poolman pointed to the Blue Cross statement suggesting future coverage and said the mandated minimums contained in the bill would come to establish the maximum levels of coverage offered by insurers, thus diminishing the overall potential for insurance provisions. To that effect, she said North Dakota's status as one of five states without an insurance provision for ABA could work to the state's advantage by leaving options open for the private sector.

Smith believed it was "hard to know" if Blue Cross actually would offer ABA coverage on its own in 2018. If those services don't come through, she said, the groups that originally brought forward HB 1434 would return to the capital for the next legislative session.

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