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Autism mandate has 'minimal' effect in Missouri

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The 3-year-old Missouri autism benefits mandate accounted for about 0.09 percent of state health insurance claims costs in 2013, according to state regulators.

Analysts at the Missouri Department of Insurance, Financial Institutions and Professional Registration found that insurers in the state reported a total of $8.3 million in autism-related claims in 2013, up from $6.5 million in 2012, according to a department autism therapy mandate impact report.

Insurers reported $3.8 million in 2013 claims for therapies affected by the mandate.

The 2010 mandate law has required state-regulated group health insurers to provide up to $40,000 in coverage for applied behavioral analysis (ABA) therapy and similar forms of therapy each year for children who have autism spectrum disorders.

Sellers of individual health insurance have had to offer consumers a chance to buy an optional autism coverage rider.

Critics of autism therapy mandate bills note that ABA therapy can cost as much as $50,000 per year.

In Missouri, insurers paid for autism-related services for 2,165 children in 2013. The average ABA therapy claim was $1,704.

Roughly one in 431 insureds received some form of autism-related treatment covered by health insurance in 2013, up from one in 548 insureds in 2012.

Missouri regulators believe that the Patient Protection and Affordable Care Act (PPACA) and U.S. Department of Health and Human Services (HHS) PPACA regulations now require sellers of individual and small-group coverage in the state to provide autism therapy benefits.

Missouri regulators say they are not sure how the PPACA ban on annual and lifetime benefits limits for “essential health benefits” will affect the state’s $40,000 cap on autism-related behavioral therapy benefits.

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