Marcus Pickett

The medical community has been making a concerted effort to raise public awareness about autism in recent years. Now, a new Missouri law could earn it more recognition when it comes to health insurance.

Missouri joined the list of states that have enacted reforms for autism insurance coverage when House Bill 1311 was signed by Gov. Jay Nixon in June 2010. The law took effect in January 2011. As with other states' autism reform laws, it seeks to improve the quality of life for autistic children and their families.

The law requires all Missouri health insurance companies to cover autism-related treatments for children under all group plans, according to Missouri's Department of Insurance, Financial Regulations and Professional Registration. Individual plans must also offer such coverage, although insurance companies can charge extra for it.

Autism is a neurological disorder that results in complex developmental disabilities. Those who have it fall along a spectrum of autistic disorders that can include Asperger Syndrome, Pervasive Developmental Disorder, Rett Syndrome and Childhood Disintegrative Disorder, with varying degrees of severity and different disabilities and behaviors.

Missouri's new law could serve as a financial lifeboat for many families who struggle with the cost of autism care. According to the Autism Society of America, the average lifetime cost of caring for a child with autism is about $3.5 million to $5 million.

What the law means for patients

According to the Department of Insurance, Financial Regulations and Professional Registration, all group and self-insured health plans that are written in Missouri or that insure Missouri residents now must carry autism coverage. Individual health plans (which are usually purchased by those who don't get coverage through their employers) do not have to automatically include autism coverage, but they must offer it. Insurance companies will be allowed to charge extra for autism coverage on individual plans to help control the cost for other customers in the individual market.

Autism coverage must include an array of treatments, including psychiatric care, psychological care, applied behavior analysis therapy, rehabilitative care and pharmaceutical care. 

For Missouri patients and their families, this means their group health insurance plans almost certainly will cover autistic health services and treatments. But they still will need to jump through the typical health insurance hoops -- like pre-certifying autism treatments, reviewing treatment plans, demonstrating the treatment is medically necessary, seeking qualified in-network providers and monitoring annual coverage limits. Although there's no limit on the number of therapy visits, the benefit currently is capped at $40,000 per year for each child, according to the Department of Insurance, Financial Regulations and Professional Registration.

The new insurance law does not apply to supplemental insurance policies. Nor does it apply to small employers (50 or fewer workers), which will be granted waivers if claims from autism coverage increase premium costs by more than 2.5 percent during a calendar year.

What the law means for health care professionals

Aside from the new health insurance standards, the Missouri law also establishes new standards of licensure for autism health professionals. To practice applied behavioral analysis (one of the most common treatments for patients with autism), health care providers must be licensed with the Behavior Analyst Advisory Board.

Other states' laws

As of Jan. 1, 2011, autism insurance coverage is required in 23 states, according to the National Conference of State Legislatures. Illinois, for example, began requiring insurance companies to cover autism diagnosis and treatment up to $36,000 a year in 2008, according to AutismVotes.org. Not every state is following the trend, however. In Michigan, the state Senate failed to vote on a House-approved measure before the end of the 2010 legislative session, sending the legislation back to the drawing board.