I'd like to call this meeting of House Insurance to order. Thank you we're going to call this meeting to order, I'd like thank our sergeant at arms Mr. Bay[sp?] Mr. Maurice, Mr Moore and Mr Cracker[sp?] thank you for your endurance test, which is always these committees. I'd like to thank our pages for being here today Jackson Parker, Emily Perry, Cayla Powell and Andrew Weatherman we appreciate you being here with us. At this time we will take up Senate Bill 676 Autism Health Insurance Coverage, Representative McGrady please explain your bill. Thank you Mr. Chairman and I'm glad to be joined by Senator Krawiec who is one of the primary co-sponsors of the bill, Senator Apodaca and I've been working on autism for a year or two now, and he asked me to carry the bill over here. As you can tell from the title, Senate Bill 676 is about autism health insurance coverage. Specifically the bill will require certain health benefit plans to offer coverage for autism spectrum disorders. The bill defines autism spectrum disorders by reference to most recent editions of two manuals, but autism is expressly curved out from the definition of mental illness in lines 43 and 44 on page 2 of the bill, and if you look at the bill the operative portion of the bill can be found on page 3 at line 16, ''Except as provided in subsection (c) of this section, health benefit plans we shall provide coverage for the screening, diagnosis and treatment of autism spectrum disorder. This reference to sub-section C is a reference to a cut or a maximum benefit of up to $40, 000 per year and it may be limited to individuals of 18 years of age or younger. The bill goes on to provide the coverage to not be denied on the basis that the treatments are habitative or educational nature but coverage may be subject to co-payment, deductible and coinsurance provisions similar to those that apply to substantially all medical services covered by the healthcare plan. Now of course the devil here is in the details when dealing with insurances this group would know better than me. So, defining terms like adaptive behavioral treatment, or who may order a treatment for autism are important, and Mr. Chairman I'd like to ask staff if they can to take it from here to cover some of the other provisions of the bill. Miss Harris? Yes Chairman. Representative McGrady has covered a lot of the bill but the main section of the bill begins on section two, and that is a new section that is going to be added to article 3 of chapter 58 that does require certain health requirement benefit plans to offer coverage for autism spectrum disorder, and as Representative McGrady pointed out the definition of autism spectrum disorder is on line 40 of page 2, and it is defined as any of the provision developed on disorder, or autism spectrum disorder as defined by the most recent addition of the DFM, or the most recent addition of the international statistical classification of the in immediate health problems. The bill also specifies that the requirement to provide the coverage for autism spectrum disorder will not apply to plans that maybe determined by federal government to require the state to or a state required benefit that is in excess of the essential health benefit and that is going to be found on page three on line 37 reporting on. As Representative McGrady stated the plans that are required to provide coverage. Coverage may not be denied because the treatment are higeltative[sp?] or educational nature. Specifically this bill will provide coverage for Doctor delayed your treatment and that definition can be found back on page two, beginning on line 18 and adaptive behavior treatment is defined as the
behavioural intervention that systematically manage a structural, instructional and environmental back groups where the consequences of the behavior that has been shown to be clinically effective through research published in purely[sp?] scientific journals and based upon minimized [xx] experimental [xx] design, and then there're criteria that it could be met to meet that definition including that the intervention must be necessary to increase appropriate or adaptive behaviors, decrease maladaptive behaviors or develop, maintain, or restore to the maximum as it extends practical the functioning of an individual, and the treatment must be ordered by licensed or licensed psychologist, and must be provided or supervised by one of the specified licensed professionals as long as the service is provided or commensurate with the licence professionals training experience [xx] Then on page 3 line 45 they'll also state that all those with diagnosed with autism spectrum disorder is removed from the mental illness benefits division of North Carolina mental health [xx] requirements. The new section does require that every health benefit plan provide coverage for autism spectrum disorder with the exception of the [xx] behavior treatment in accordance with the federal mental health then sections one, three, four, and five make conforming changes that autism spectrum disorder is not [xx] other [xx] That takes us through the the details of the bill and I appreciate the help there. Politics as we all know is the art of the possible and this bill reflects what I know is possible. The the House bill that I introduced and over 40 of my colleagues are co-sponsors most significant difference with the senate bill relates to Autism being called up from the definition nano [xx] and that does not provide Health parity for those seeking treatment of an Autism Spectrum Disorder, I view this bill as increamentaly getting us where we need to be and I urge you to give the bill a favorable recommendation I should add again that this bill is essentially the same as the bill that I co-sponsored along with representative Shepherd [xx] and representative [xx] and former representative Molly [xx] passed the house by a vote of 105 to 7. I think we are long past arguing whether over there should be intense coverage for autism and we had 40 responses for last sessions bill we are past that. This session and again I hope that the committee will give the bill a favorable recommendation. That's my presentation, Mr. Chairman. Thank you. Representative Howard. Mr. Chairman, when you're ready I've prepared to give render a motion. Thank you. Representative Shepard. I was going to do the same, but I do have a question Mr. Chair. Proceed. For Representative McGrady. Representative on the list of them, those that are covered here by the autism insurance are ABA Council of Officers program and this. What are they? I thought it was in the other bill we passed last week. Miss Harris, can you help me on that one? What was the question [xx]? The ABA Councils are they covered under the list here? Would they be what you would call a Licensed Occupational Therapist or a Professional Counsellor. And by ABA are they referring to Applied Behavior Analysts? Yes. They are not listed as one of the professionals that are under this bill. Let me respond further, if you remember we have passed in the House a bill put forward by Representative Jeter, I believe it passed unanimously or near unanimously. That bill does have a connection to this bill and my hope is that the Senate will take up that bill and thus supplement what is in the Senate bill here, but I've agreed that I'd try to run a clean bill in the House committee, so that's why it's not here. Follow up. Follow up. Mr. Chair, I just want to make a statement. I appreciate Representative McGrady working on this. Like he said, we've been working
on this to get help for all autism, people with autism, children with autism for the last several year and in my community the military kids have a higher rate of autism for some reason or other than the average and this is very important for them, and the other bill that we passed in the House is very important. So I hope the Senate will take that and move it on because it directly affects some military children, bill will be passed. So thank you all for your hard work and I know this will be good for our autistic children. Thank you. Representative collins.yes.mr. Chairman I have a question and I think will lead to one follow up, and it's kind of more general question towards what Representative Shepard was asking, and I'd like to ask I guess maybe staff, are there competing methods for treating autism and if so, are we choosing a subset of those to insure or are we insuring the person no matter which route the Duke takes. Have some folks in the audience who could answer that one. Is there anyone from the public that could answer that question? if you will please approach the microphone at the back. State your name for the record please. I'm Sally Carman and I'm the Executive Director of the North Carolina Psychological Association. It is my understanding that they way the definition is written it will cover the wide range of treatments that persons with autism receive, whether they are receiving applied behavioral analysis, or the type of things that North Carolina Teach Program does, or the Duke Center for Autism. So it includes a type behavioral analysis and other modalities that help people with autism. Stay there for one follow up. Follow up. Is this thing broad enough to where we will not, let's say two years from now somebody comes up with another treatment and maybe it's wonderfully more effective and less expensive and everything else, will this legislation preclude any new treatments that come up for autism? Well, it's my understanding that that is why it is written the way it is, that as long as it's evidence based research published in a peer review journal that that would be included. Thank you. Thank you. Representative Horn. Thank you, Mr. Chairman. Seems to me that either we're much more aware of autism today than we've ever been before or there is a dramatic increase in diagnosis of autism which leads me to my question which is has the definition of autism or autistic disorder changed dramatically in the last five years? Please. The definition of Autism Spectrum Disorder, that has been updated and came into fruition per the DSM in May 2013, that's where Autism Spectrum Disorder came [xx] 2013. Follow up, follow up. The only concern I have and I'm very encouraged with this bill, strongly support it, but the concern I have is as the definition has changed how much more will it change, and how much more expensive will it become and is there inherent in this some stability in that definition in this bill, some stability in that definition so that we kind of know what we're up against? As you know everything is a moving target we do so we're just try to hit the target as we're moving. If I could respond the definition here though is not a definition that we're fixing in some manual, we're referring to the two professional manuals that define it. So yes the definition could changed, but we're not going to be in a position of having to come back and change the legislation because somebody has defined it broader or narrow we're relying on the technical manual and put together to find that term as opposed to defining it on our own Representative Horn. Representative Insko. Thank you. I have a couple of questions why it has to do with licence here, are adaptive behavior treatment counselors licensed by the State of North Carolina? but I [xx] I guess. Is their state licence your requirements for adaptive behavior counselors? Currently get the answer.
Miss Cameron Oviet[sp?] please, madam please step forward and state your name for the record. My name Miss Lorri Unumb, I'm Vice President of State Government Affairs at Autism Speaks. I couldn't hear the question that well, but I think the question was are the providers of adaptive behavior treatment licensed? By the State of North Carolina. So adaptive behavior treatment is a broad umbrella term as Sally Cameron mentioned earlier, and there could be various types of providers. The primary treatment, the Applied Behaviour Analysis which is the most commonly prescribed treatment for autism and also the one that's currently not covered by insurance, is provided by a Behavior Analyst. They are not listed in the list of reimbursable providers precisely because they're not licensed by the State of North Carolina, but that's what Representative Jeter's bill that you all passed last week or so would do. So House Bill 714 creates a State licence for behavior analysts, and our hope is then that they would be reimbursable providers under the bill. Thank you. Thank you. Follow up Representative Inske. I'm interested in page 3 Section C on line 21, if someone could talk a little more about the total cost of coverage for annually. This is a insurance it could be up to $40, 000, but on top of that there could be co-pays and co-insurance. I'm a little bit interested in what the total could be for a more serious case of autism or if anybody knows may be we currently do cover that. The average cost. Or average cost for a year? I am not aware of that information. It would depend upon the fact specific situation you have, and the type of underlying coverage because the bill basically allows for the similar types of co-pays, deductibles and what not and that you'd sort of fall back on the policy that was there. Mr. Chairman, there may be Miss Unumb can try to answer that if, hopefully I didn't get it wrong. You did not get wrong, Representative McGrady. Again Lorri Unumb, for the record. I can give you some data from your neighbor State to the south about the average cost of adaptive behaviour treatment. I live in South Carolina, and we've had this coverage since 2007. Our law has a $54, 000 cap whereas this has a $40, 000 cap. $54, 000 or $40, 000 would be sufficient for the vast majority of children with autism. My own son happens to be very severe on the spectrum and his has exceeded that, it costs about $70, 000 a year. So it would not be sufficient for a severely autistic child who needs very intensive behavior treatment, but I can tell you that the average cost of an ABA program in our State Employee Health Plan, which covers about 10% of our population in South Carolina it's running about $14, 000 a year. Ok, that's helpful [xx] So the vast majority of children with autism are more mildly affected and it's running around 14, 000. Thank you. Thank you. Yes Ma'am. Representative Lambeth. Two quick questions somewhat related to that, Section C. The consumer price index, was there any thought given to the health care consumer price index which does vary in some years quite a bit from the CPI? I can't answer that question because this is a Senate Bill and is not an issue that we have ever, that has ever been discussed to my knowledge. Second question relates to age maximum of 18, what happens when they turn 19? Is the predominant environment out there that most plans don't cover an adult or in fact do they cover adults with autism? We maybe want to turn to the Vice President with Autism Speaks to ask what the predominant method is, but you're understanding it right. That is, in the Senate bill there is an effort here to sort of cap the cost in some ways, and one of the ways you cap it aside from putting that $40, 000 figure in there is you put the 18-years or younger in there and you're cutting off, we're cutting off some people that might otherwise be covered. Again, and Mr. Chairman she can correct me if I screwed up again.
Again you have not. It's political compromise, and unfortunately a phenomenon that we're facing is that children with autism when they reach the age 18 or 21 are falling off of a cliff largely. That's another issue that the legislature is going to have to address, but as of last night there are now 42 States that have passed autism insurance mandates like the one in front of you and probably 75% of those have some sort of age cap written on adaptive behaviour treatment, about 25% of them do not have an age cap at all, we'd like to get there but I understand the incremental nature of legislation. Thank you Mr. Chairman Thank you Senator. I'm Senator Crawvic[sp?] and I just want to briefly thank you Mr. Chairman, I want to thank Representative McCready I'm kind of new to the game but one of my first priorities when I arrived was to pass an autism insurance bill and representative McCready has been working on this diligently as you know for many many years and I just want to thank him for his efforts and Loury Eunime from Autism speaks done a tremendous job being here educating all of us in this issue and the need for it in North Carolina so I appreciate your support thank you all Representative Howard. Mr. Chairman, I would like to move that we give a Favorable Report to Senate Bill 676. Members of the Committee, you've heard the motion on the floor. Any further discussion or debate? If not, all in favor say Aye. Aye. All opposed? Motion carried. Thank you all for your time and patience, this meeting is adjourned.