Ava’s Law – How Will it Affect Individuals With Autism In Georgia?

 Read the great article about Georgia Insurance reform:

Ava's Law – How Will it Affect Individuals With Autism?
By D'Arcy Robb

During the 2013 Georgia General Assembly, a bill known as Ava's Law (HB 309/SB 191/HB 559), was introduced that would require insurance plans to provide coverage for a range of autism therapies. Ava's Law is named after eight-year-old Ava Bullard from Lyons, GA, who has autism and whose mother Anna, started publically leading the effort for change after her insurance company would not cover the costly treatments. The original House Bill 309 is sponsored by Representative Ben Harbin; Senate Bill 191 is sponsored by Senator John Albers and House Bill 559 is sponsored by Representative Chuck Sims.

Ava's Law did not pass out of the House or Senate chamber this session, but it is currently being reviewed by the non-legislative health insurance mandates committee, which will make a recommendation on Ava's Law before the 2014 legislative session starts. In Georgia, many disability advocates are passionate supporters of Ava's Law, but there are also some advocates who object to the bill. Below is a breakdown of Ava's Law and what it is proposing.

What Would Ava's Law Do?
Broadly speaking, Ava's Law would require insurance plans in Georgia to cover a range of behavioral health therapies for autism spectrum disorders for up to $50,000/year to be adjusted each year for inflation.

Ava's Law would not apply to those covered by Medicaid, and not all of Ava's Law will necessarily apply to those who will be covered by "qualified health plans" offered under the health benefits exchange as per the federal Affordable Care Act. The qualified health plans are required to provide essential health benefits, as defined broadly by the federal government and more specifically by each state. The federal essential health benefits include "behavioral health treatment" but do not make any specific mention of Applied Behavioral Analysis (ABA).

VOTE FOR AVA'S LAW :

http://www.autismspeaks.org/advocacy/state/georgia

ABA Therapy And Insurance Coverage.

What have states done to help ensure coverage of autism therapies?

Starting with Indiana in 2001, a total of 34 states and the District of Columbia have enacted autism insurance mandates, requiring carriers within their borders to provide coverage of ABA and other autism treatments in some or all of their policies.

States require insurers to cover nearly 2,300 categories of illness, treatments, and screenings.  Every state with an autism mandate requires insurers to cover ABA for state employees. Beyond that, state laws vary widely. 

What Does That Mean?

he ACA says state insurance mandates in place before Dec. 31, 2011 may apply to policies offered on the exchanges.  If a state requires commercial carriers to cover ABA, that same requirement may be applied to policies sold on its exchange.

However, when the administration directed states to define “essential benefits,” every state either chose a “benchmark plan” (defined as the small business plan in the state with the most beneficiaries) or let the federal government choose a similar plan for them. If a state’s benchmark plan includes a requirement to cover ABA and other autism treatments, then all the plans on its exchange must do the same.

What that means, there are many States that do not Have Autism Mandate and the States that do are relatively new and the coverage has not began being enforced.

At Compass we hope one Day each child dealing with Autism will receive appropriate care. We are committed to provide reassures and information for each caregiver so they can be informed and educated in treatment options they have for their child.