Increasing required medical coverage for autism spectrum disorders
The proposed changes under SB80 would enhance the state laws governing mental health and autism treatment by ensuring that more comprehensive coverage is available. Currently, the legislation specifies maximum benefit limits for ABA and prescribes a charge structure based on the assessed needs and diagnosed conditions of the individual. It mandates annual coverage maxima for ABA treatment of up to $90,000 during the initial three years and continued monthly coverage thereafter until the individual turns 18, given that treatments remain medically necessary. This could significantly alleviate financial burdens on families seeking necessary treatments for children with autism spectrum disorders.
Senate Bill 80 aims to amend various sections of the Code of West Virginia related to the insurance coverage requirements for autism spectrum disorders. The primary purpose of the bill is to increase the mandated medical coverage for individuals diagnosed with autism ranging from ages 18 months to 18 years. This would include coverage for essential treatments, evaluations, and diagnostics that are deemed medically necessary and prescribed by licensed healthcare professionals. Notably, applied behavior analysis (ABA) is highlighted as a critical component of the treatment plan, which is to be provided by certified behavior analysts.
The sentiment surrounding SB80 appears to be broadly supportive among advocates for autism services and families of affected children, as it signifies a move toward more extensive coverage and healthcare support. However, there may be concerns from insurance providers regarding the potential increase in costs due to mandated benefits. The legislation may face scrutiny in regard to its fiscal implications and the requirement for insurers to comply with these enhanced coverage standards.
One notable point of contention regarding SB80 is the financial implications for insurers and the state’s insurance market. Stakeholders may express concerns about the viability of maintaining these coverage levels without adverse effects on premiums or the availability of insurance plans. Furthermore, there could be discussions about whether the bill adequately balances the needs for enhanced coverage against the operational realities faced by insurance providers. Proponents may argue that the benefits, particularly for those affected by severe autism, far outweigh potential financial drawbacks, emphasizing the essential nature of the proposed treatments.