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N.D. House passes autism bill on second vote

A bill to extend North Dakota insurance coverage for services to treat autism was approved Wednesday by the House a day after it failed to pass by just one vote.

Among other things, HB 1434 specifically would require insurance companies in the state to provide coverage for applied behavioral analysis, a widely used therapy method used for autistic children.

The therapy, also known as ABA, was not previously covered under most health insurance policies offered in North Dakota.

Rep. Thomas Beadle, R-Fargo, described the bill Tuesday as a product of "grassroots efforts" of North Dakota parents of children with autism.

"Having a family member on the autism spectrum is a life-changing event," he said, citing data on the treatment costs and diagnosis levels of the disorder. "This is a huge issue, and it's a huge issue for a lot of families in our state."

Beadle said the bill was based on legislation already approved in more than 40 other states and reworked by a legislative policy committee.

As written, HB 1434 would require North Dakota insurance policies to provide coverage for "the screening for, diagnosis of and treatment for autism spectrum disorder" in insured people under age 19. The bill would not allow insurers to terminate the coverage of such people solely because of an autism diagnosis or treatment plan.

The proposed legislation would require insurance coverage for ABA therapy to provide an annual maximum benefit that could not be less than $36,000 for individuals age 7 and younger; $25,000 for individuals between ages 7 and 14; $12,500 for individuals between 14 years old and less than 19.

ABA studies suggest the therapy has its greatest impact in younger patients.

The insurance commissioner would be required by the bill to submit a biennial report to legislative management regarding the use of the obligated autism coverage. That information would include such statistics as the total number of insured people being diagnosed with autism and the total cost of all claims paid out in the biennial period.

Beyond inpatient services, the bill would allow insurers to review treatment plans at least once annually for insured individuals receiving autism-related treatment.

HB 1434 was first heard Tuesday by the House, when it failed by a vote of 47 "yes" votes to 29 "no" votes. The threshold for passage is 48.

State policy allows bills to be reintroduced on the floor if a lawmaker who initially submitted a "no" vote changes their position within a 24-hour period.

Rep. Nathan Toman, R-Mandan, made the motion Wednesday to resurrect the bill. That motion was accepted, and after some discussion, representatives passed the bill 61-29.

Representatives who opposed revisiting the bill spoke against the use of legislation to prompt the change in coverage.

Rep. Dan Ruby, R-Minot, urged legislators to not reconsider the Tuesday vote. Ruby said representatives from Blue Cross Blue Shield North Dakota have indicated the insurer will begin offering coverage for ABA on Jan. 1, 2018.

Ruby said the BCBS plan could be better than the coverage required by HB 1434 and that legislating the issue could cause "a bigger problem in the long run."

Rep. Robin Weisz, R-Hurdsfield, said the plan suggested by BCBS would target benefits to autistic children in the "critical ages" from birth to age 12.

"They'd have unlimited benefits, but they won't if (BCBS) has to cover up through the ages that are listed in this current legislation," he said.

Beadle commended the work of BCBS but said the bill would also require Sanford Health Plan, the second largest insurer in the state, to follow suit with ABA coverage.

Janice Kern, a coordinator of the North Dakota chapter of autism advocacy group TACA, said she was happy with the Wednesday vote.

"This legislation makes all insurance companies in North Dakota be accountable and step up to the plate to cover this treatment," said Kern, whose son has autism.

Kern said her family had to get "creative" to provide ABA therapy for her son. She and her husband ended up getting training to do the therapy themselves and also saw to it that their child's babysitter was trained in ABA.

After the Wednesday vote, Kern said she didn't doubt BCBS was working on coverage for ABA. Still, she said the therapy had gone uncovered for too long to keep waiting for coverage without the help of legislation.

"We've already waited 13 years, and I don't see this in writing," said Kern. "They're saying they will cover this, and I do believe that they will, but they're not the only insurance company and this (legislation) would cover more people in North Dakota."

Andrew Haffner

Andrew Haffner covers higher education and general assignment stories for the Grand Forks Herald. He attended the University of Wisconsin in Madison, where he studied journalism, political science and international studies. He previously worked at the Dickinson Press.

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