February 04, 2013

Department of Insurance report shows more than 1.6 million Missourians covered by new autism law

Second annual report: Total claims less than 2/10 of 1 percent of health care costs

Jefferson City, Mo. - A new report from the Missouri Department of Insurance shows that the state's autism insurance law continues to benefit families affected by autism while having minimal impact on health care costs. A 2010 law, signed by Gov. Nixon, requires health insurance companies to cover specific autism therapies, including applied behavior analysis. The department's report, released today, says demand for these treatments increased more than 50 percent in 2012.

Using data supplied by health insurance companies, the report says total insurance claims for autism-related treatments were $6.6 million in 2012. That figure is 52 percent higher than claims paid in 2011. Still, the number accounts for a small fraction - just 0.16 percent - of total claims paid by health insurers during the year.

In addition to claims for general autism treatment, demand specifically for applied behavior analysis jumped 183 percent from 2011 to 2012.

"Missouri's new landmark autism insurance law continues to deliver benefits for families impacted by autism," said John M. Huff, director of the Missouri Department of Insurance. "Especially encouraging is the extremely low impact on overall health insurance claims."

Missouri law does not require health insurance companies to submit their rates to the Department of Insurance, but Huff says the overall claims numbers suggest minimal, if any, impact on the premiums consumers pay.

Other noteworthy findings of the department's report:

  • 1.6 million Missourians are covered by a health plan that offers coverage for autism therapy, specifically applied behavior analysis.
  • All policyholders in the large- and small-group markets now have insurance coverage for autism treatments.
  • The law allows insurers in the individual market to offer autism coverage as an extra, with an added cost. Some companies offer it as a standard provision in every policy. As a result, about one-third of consumers enrolled in the individual market have this coverage.
  • 187 licenses have been issued by the Missouri Division of Professional Registration for behavior analysts and assistant behavior analysts, who are required to be licensed under the new law. That number is up 39 percent from last year, an indication that access to professional therapists continues to grow.
  • The average monthly cost of treatment for individuals diagnosed with autism was $242 in 2012.

Benefits to increase in 2013
The law originally required health insurance companies to cover $40,000 for applied behavior analysis therapy per policyholder, to be adjusted yearly by the director of the Department of Insurance using the Consumer Price Index. Huff on Jan. 23 signed an order increasing the maximum benefit to $42,117 for 2013.

In 2012, the average policyholder receiving treatment saw $2,904 in autism services, just 7 percent of the annual maximum benefit.

Enforcement of the law in 2012
The Department of Insurance is charged with enforcement of the new autism law. In 2012, the department mediated consumer complaints regarding the insurance coverage of autism, and one health insurance company paid the largest insurance fine, $1.5 million, in Missouri history for violations of the autism law.

The Department of Insurance has extensive resources for families and health care providers on its website. Consumers and providers with complaints or questions call the department's Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.