With the North Carolina General Assembly’s long session now concluded, legislation that would have required all health insurance companies in the state to cover the diagnosis and treatment of autism won’t become law this year.

But the Autism Society of North Carolina, a nonprofit advocacy group based in Raleigh, says the complementary Senate and House bills  in committee could be revisited during the General Assembly’s short session beginning around in May 2012.

Senate Bill 115 has been in the Senate’s Committee on Insurance since Feb. 24, the day it passed a first reading in the Senate and a day after it was filed. Comparable House Bill 826 similarly has been in the House’s Committee on Health and Human Services since the House passed a first reading of it April 7.

Jennifer Mahan, director of government relations for the Autism Society of North Carolina, said Monday, “in general, insurance law that mandates additional coverage is never popular in North Carolina.”

But the stance the Autism Society will continue to take, Mahan said, is that individuals with autism, a complex range of neurodevelopmental disabilities, should have their diagnoses and treatments covered by their health insurance plans.

“We just think it should be covered, period,” she said. “It’s a discriminatory issue.”

Attempts to pass a law in North Carolina mandating health insurance coverage for people with autism have been stymied before.

In 2008, Mahan said work was done to raise awareness of the issue. During the 2009 long session of the General Assembly, bill language was crafted but then was not going to be heard so the Autism Society had autism insurance added to a list of items being looked at by a Joint Autism study committee of the legislature. An autism insurance bill was introduced during the 2010 short session, Mahan said, resulting in a two-day Senate committee hearing but with no vote taken.

The General Assembly had another long session in 2011, and Mahan said this meant everything got “reset” with the new bills now in committee being introduced.

The proposed bills would have included requiring the state health insurance plan to cover autism diagnosis and treatment, which in turn had state spending implications during a session keenly focused on tightening government expenditures statewide.

Mahan said a legislative fiscal note attached to the proposed legislation put the cost at an additional $10 million to $13 million a year for the state health plan, though Mahan said the Autism Society think the cost would be more in the range of $5 million to $7 million a year.

“We think there’s a significant ramping-up period,” she said, which would decrease initial cost estimates. For example, Mahan said, South Carolina has seen about half of the expected utilization of state-mandated autism diagnosis and treatment coverage than expected.

In addition to cost issues, opposition to the proposed legislation has come from Blue Cross and Blue Shield of North Carolina, the largest health insurance provider in the state with about 3.7 million customers. The health insurer maintains that the legislation is unnecessary because BCBSNC already provides coverage of the diagnosis and treatment of autism.

But a point of difference relates to applied behavior analysis, or ABA, therapy for people with autism. The insurance company’s medical directors have determined ABA therapy is educational rather than medical. Others like the Autism Society of North Carolina disagree, saying medical research has indicated that ABA therapy is a medical and not educational treatment.

More about autism in Western North Carolina

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Kathleen O'Nan is a contributing reporter to Carolina Public Press.

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  1. This is the typical battle that plays out in all the legislative battles across the country. Insurance companies and lobbyists point at the expensive treatment of ABA and say it’s “educational – That belongs to the public school district to provide.” Then the schools rail back and declare, “Check out what the surgeon general says about ABA, it’s scientifically and the most proven and effective treatment for the early intervention of autism.”

    Sadly, the fight state by state is following the same script. All in the course of short term thinking. Most people do not understand that the cost incurred from a denial of these proven treatments will lead to a lifetime of state welfare and increased tax burden as these children become adults and continue to tax Medicaid.