NJ Insurers To Be Required To Cover Autism Treatment

TRENTON – A bill which would require health insurers in New Jersey to provide coverage for screening for autism and other developmental disabilities as well as any medically-necessary occupational, physical and speech therapy, was approved by the state Senate on June 18 by a vote of 35-0.

“New Jersey has one of the highest rates of autism incidence in the entire country, and we have to do more for families struggling to get their loved ones the treatment they need to mitigate the effects of the disorder,” said Senator Joseph Vitale, D-Middlesex, and chairman of the Senate Health, Human Services and Senior Citizens Committee.  “

Insurance companies have a sacred responsibility to provide access to medically-necessary and scientifically proven care which can help improve outcomes for autistic children.  Through this legislation, we’re making sure that insurers live up to that responsibility and cover the treatment and therapy which will make a difference in the lives of autistic children.”

The bill, S-1651, would require that insurers in New Jersey would be required to provide insurance coverage for diagnostic and therapeutic services designed to identify and treat autism and other developmental disabilities.  Under the bill, insurance companies would be required to provide up to $36,000 per year in coverage for medically necessary behavioral early intervention for all autistic patients under 21 years old. Beginning Jan. 1, 2012, the Department of Banking and Insurance would adjust the maximum benefit to reflect inflation according to the consumer price index.

The sponsors noted that research has demonstrated that early intervention services, which include speech, physical and occupational therapy, help the majority of young children with autism and other developmental disabilities to learn important skills.  Additionally, numerous studies have shown that early treatment of autism spectrum disorders through behavioral intervention may serve to mitigate many of the problems and challenges associated with the disorder.

Currently, ten states nationwide have enacted some form of legislation requiring insurance coverage of autism treatment.  Most have some form of cap on expenses paid out by insurers – ranging from $36,000 to $50,000 – and most cap the age limit at which insurers must cover treatment – ranging from 6 years old to 21 years old.

“We’re not imposing an unfair burden on insurers, but simply asking them to live up to their responsibility to cover treatment for their subscribers,” said Vitale.  “Ten other states around the nation have done the right thing and mandated insurance coverage for autism spectrum disorders and developmental disabilities.  Given the epidemic proportions of the disorder in the Garden State, it’s time New Jersey joined the other ten states that have already guaranteed coverage for the treatment of autism and other developmental disabilities.”

The bill now heads to the Assembly for concurrence with Senate amendments.

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