Autism in the Health-Care Debate: House of Representatives
Thursday, November 5, 2009
By: Hannah Cary

Help keep autism insurance and autism interests in the debate

After the three committees of jurisdiction marked up the House bill on health-care reform, the mark-ups have been combined to create HR 3962, better known as the “Affordable Health Care for America Act” (previously, the House health-care bill was numbered HR 3200, but was renumbered after the mark-ups were consolidated). The provisions in the bill that benefit people with disabilities and chronic conditions are far too many to list in this brief update, but the following provisions stand out as signature achievements of the legislation for our community:

• Major insurance market reforms such as the elimination of discrimination based on health status, a prohibition on pre-existing condition exclusions, guaranteed issue and renewal requirements, and elimination of annual and lifetime caps;
• Creation of a high-risk pool to provide immediate assistance to those currently uninsured with pre-existing conditions before insurance market reforms are implemented;
• Inclusion of critical services for people with disabilities in the new Health Insurance Exchange’s essential benefits package, such as rehabilitation and habilitation services, durable medical equipment, prosthetics, orthotics and related supplies, vision and hearing services, equipment and supplies for children under 21 years of age, behavioral health treatment, and mental health and substance abuse  services in compliance with the Wellstone-Domenici parity law;
• Inclusion of the Community Living Assistance Services and Supports (CLASS) Act, a new actuarially sound, premium-based, national long-term services insurance program to help adults with severe functional impairments to remain independent, employed and a part of their communities, without having to impoverish themselves to become eligible for Medicaid;
• Significant investments in Medicaid to dramatically expand eligibility, including EPSDT services for millions of children, increased reimbursement for physicians of Medicare rates with significant federal funding to offset the burden on states, a Maintenance of Effort (MOE) provision, and a six month-extension of the American Recovery and Reinvestment Act’s increase to the federal share of Medicaid spending;
• Substantial federal subsidies and out-of-pocket limits to make coverage as affordable as possible;
• Patient protection in the context of coordinating care and bundling payments (including the concept of continuing care hospitals (CCH) for the benefit of people with chronic conditions and disabilities.);
• A two-year extension of the exceptions process to the Medicare therapy caps on physical, occupational, and speech and language therapies;
• Requirements for the development of standards for accessible diagnostic and other medical equipment;
• Inclusion of “disability” as a category for purposes of health disparities;
• Inclusion of “disability” as a subpopulation in the provisions regarding Comparative Effectiveness Research (CER), and ensuring that CER is not used to inappropriately mandate payment, coverage or reimbursement policies; and
• Provision of wellness grants that prohibit the use of discriminatory incentives.

This bill incorporates two amendments added by Representative Doyle (D-PA) that are relevant to autism. The first requires the coverage of behavioral health treatments, and is mirrored in the Senate Finance Committee health-care reform bill in an amendment added by Senator Menendez (D-NJ). The broadly written language of “behavioral health treatments” seeks to cover treatments such as Applied Behavior Analysis without restricting families to narrowly defined treatments.

The second amendment offered by Representative Doyle that was incorporated into the bill is section 2527, titled “National Training Initiatives on Autism Spectrum Disorders.” This amendment would provide funding for the Association of University Centers on Disability (AUCD) and other non-profits to provide trainings and technical assistance to professionals engaged in education related to autism spectrum disorders. This provision will enhance model services and supports, and expand the availability of evidence-based services, lifelong interventions, education, employment and transitional services, and community supports to people with autism.

The Autism Society sees both provisions as positive for expanding choices for people with autism and their loved ones. We thank Representative Doyle for his commitment to advocating for those affected by autism. Click here to thank Representative Doyle.

Speaker Pelosi has said that she would like to see a final vote before November 11, but a firm timeline or procedural rules for a floor vote are unclear.

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