Autism Insurance (WI, 2009-2012)

On June 29, 2009, Governor Jim Doyle signed Wisconsin's biennial budget bill and an autism insurance requirement became a legal reality in the state of Wisconsin. The story, as told by Elvis Sightings between 2009 and 2012, appears below. The most recent updates are at the top; to get the story in chronological order, you might want to read from bottom-up.

Top Links:
WI OCI Rule on Autism Insurance (in PDF) -- this is the final rule, that went into force October 1, 2010
- Autism Mandate FAQ from DeanCare
- FAQ on Autism Insurance in Wisconsin from Autism Speaks / Autism Votes.
- LRB 1529 - an un-introduced bill (Vukmir/Nygren 2011) that would allow individual insurance plans in which individuals could choose to opt out of mandates.
- LRB 0373 an un-introduced bill (Vukmir/Nygren 2011) that would allow out-of-state health insurance companies to offer plans in Wisconsin that comply with their own state's mandates (or lack thereof) instead of Wisconsin's.

UPDATE 1/23/2012 - The bills that were circulating in winter 2011, that would have killed Wisconsin's autism insurance requirement and other mandates as well, were never introduced. As that threat has temporarily waned, a new issue has arisen: federal health care law, and autism benefits under the Affordable Care Act. The current proposal from the U.S. Dept. of Health and Human Services would allow states to choose a "benchmark" healthcare plan to serve as a minimum reference for all other health plans, both public and private. Autism Speaks has posted an excellent article describing the situation: Federal Health Care Law Allows States to Decide Autism Benefits Package (Dec. 27, 2011).

UPDATE 4/28/2011 - Elvis Sightings has compiled a list of Wisconsin legislators who either co-sponsored or voted in favor of autism insurance, and are still serving today! Thanks are due -- along with a reminder that the Vukmir/Nygren bills would undo their good work.

UPDATE 4/28/2011 - Autism insurance gets a reprieve in Arizona, thanks to a veto by Gov. Jan Brewer (vetoing a bill much like the out-of-state insurers bill that is waiting to be introduced in Wisconsin).

UPDATE 4/25/2011 - Anyone in Wisconsin can help let the WI Department of Health Services know: autism insurance and other insurance mandates save money for the state's Medicaid programs. Elvis Sightings post: Autism Insurance = Medicaid Savings: Pass it On!

UPDATE 3/28/2011 - It turns out that the not-yet-introduced bills that would kill Wisconsin's autism-insurance mandate (and all the rest of our mandates) -- come to us from out of state, via ALEC, the conservative American Legislative Exchange Council. Read Shawn Doherty's excellent 3/27 piece in Madison's Capital Times (State GOP Health Bills Mirror Model ALEC Legislation), and my Elvis Sightings piece as well.

UPDATE 3/18/2011 - Autism Society of Wisconsin president Nissan Bar-Lev has e-mailed some helpful information about the (not-yet-introduced) insurance-related bills.

"Two new pieces of legislation have been circulated at the Capitol by Senator Leah Vukmir (R-Wauwatosa) and John Nygren (R-Marinette). Both bills propose changes to the insurance mandate put into place during the last legislative term. LRB (Legislative Reference Bureau) 1529 would provide health insurance purchasers with information about mandates and their associated costs, and would allow specifically qualified individuals to purchase "ala carte" insurance plans which do not include coverage for mandates. LRB 0373 would allow out-of-state health insurer companies to offer plans in Wisconsin that comply with their own state's health insurance coverage mandates (instead of Wisconsin's).

Both are ways around the mandate. They do not kill the mandate, but they provide ways in which insurance companies can get around it and legally NOT provide insurance coverage for autism services.

We are not expecting activity on either of these bills until possibly fall. This is due to the activity in Madison around the recently passed budget repair bill, the new biennial budget proposal and recall initiatives. Legislators and their staffers are very busy rolling immediately into "election mode," the tension at the Capitol is at an all-time high, and people are focused on other more immediate issues....

In the mean time, we can take action to begin public opposition for these bills.... contact your legislators and tell them NOT TO SUPPORT LRB 1529 and LRB 0373."

UPDATE 3/7/2011 - There are two bills currently circulating, reportedly to be introduced this week, that (as summed up by Shawn Doherty of the Capital Times) "would allow insurance policies in Wisconsin to ignore state mandates requiring coverage for a broad variety of medical treatments and conditions, including autism, cochlear implants and mental health problems."

Autism insurance is suddenly at grave risk. I write about my own family's situation in the post Now They're Coming for her Autism Insurance. I will post further updates and action alerts as advocacy efforts are organized.

UPDATE 11/11/2010 - I've written a new post with some information on mental health parity in Wisconsin, and how that interacts with autism insurance -- the effect in at least some cases will be to eliminate the $50,000 (intensive) and $25,000 (post-intensive) insurance spending caps.

UPDATE 5/17/2010 - Governor Doyle has signed into law WI Senate Bill 667, providing for the licensing of behavior analysts in the state of Wisconsin and modifying the Wisconsin autism insurance requirement to include services provided by (or under the supervision of) licensed behavior analysts.

UPDATE 1/21/2010 - A new FAQ about Wisconsin autism insurance and the autism waiver has been published by the Department of Health Services (DHS). This has different content than the one published by the OCI, below. The OCI FAQ focuses entirely on the insurance side of things; the DHS FAQ addresses questions of how the insurance and waiver services will coordinate. This is worth a post of its own, but I'm seeking answers to a few more questions before I add my own opinions!

UPDATE 1/6/2010 - An updated Frequently-Asked Questions document (.pdf) about the autism insurance mandate, from the Office of the Commissioner of Insurance, has been posted at the Autism Society of Wisconsin web site (FAQ revision date 12/22/09).

UPDATE 11/18/2009 -- The Office of the Commissioner of Insurance has announced the public hearing for the emergency administrative rule on the autism insurance mandate which was published last month (announcement is a PDF file and includes the rule itself). The hearing will be held Wednesday December 2 at 2pm. Comments may also be submitted by postal mail, e-mail, or hand-delivered, up to two weeks after the hearing. For anyone looking ahead at how the administrative rule-making is likely to go from here, here is a primer (in PDF) on how the process goes in Wisconsin. Hat tip to JoyDad for providing these links!

UPDATE 10/20/2009 -- The administrative rules pertaining to Wisconsin's autism insurance requirement have been published by the Office of the Commissioner of Insurance. Read Elvis Sightings' link & update here.

Update 7/21: A working group has now been assembled to assist in the sausage-making crafting of the autism insurance rules. I like the fact that the group has 3 legislators (all authors of the legislation), 4 advocate members, 3 treatment-provider members, 3 members of the public, 2 Dept. of Health Services members -- and only 3 insurance company representatives. Nice mix! They will work toward a September deadline.

UPDATE 6/29/2009 -- It's official! Governor Doyle has signed the budget bill (on time for the first time since 1977). Insurers in Wisconsin will now have to cover evidence-based autism treatments, to the tune of up to $50,000 per year for intensive-level services, and $25,000 per year for post-intensive services.

Now comes the REAL sausage-making: the crafting of the rules under the aegis of the Office of the Commissioner of Insurance.

See post from 7/1: Forward! (Autism Insurance in Wisconsin)

Update 6/27: The Wisconsin Assembly has now followed suit and passed the budget measure as well, with a 51/46 vote. Onward to the Governor's desk... it will be official soon!

Update 6/26: Beelzebub is strapping on ice-skates -- the Wisconsin state budget might actually be done on time (by July 1)! The conference committee accepted the Assembly version of the autism insurance provision, with the $50,000 and $25,000 coverage requirements and the evidence-based requirement for both intensive and post-intensive treatments. (Search for "autism" in the Comparative Summary of Recommendations PDF document to see how it played out.) The WI Senate approved the measure yesterday, on a 17-15 vote -- no further amendments allowed. The WI Assembly will take it up this evening, same deal, no further amendments. Then if it passes as expected, it goes to Governor Doyle, who will likely have some choice vetoes to make but it's hard to imagine him doing anything to spike the autism insurance after being so openly in favor.

Update 6/18: The Wisconsin Senate has now passed their version of the state budget (just before 9pm Wednesday), 17-16. They started with the version of the budget recommended by the Joint Finance Committee, which had the $60,000/$30,000 numbers, and left the autism insurance provision untouched in the version they passed. (Here are the amendments they made; the autism provision is not mentioned as it went unamended.) Next step: the conference committee, which obviously will need to reconcile the two versions of the autism insurance provision.

Update 6/13: I missed one other change in the amendment -- it specifies that post-intensive treatment must be evidence-based, which matches what the provision already said about intensive treatment. Of course the devil's in the details, but evidence-based is generally a worthy goal for health-care interventions! At any rate, the WI Assembly voted on and passed their version of the budget early this morning. Now the Senate can choose to either take up the budget as passed by the Assembly, as it came out of Joint Finance, or as it was originally presented by the Governor. If they pass something that's different from the Assembly, then it goes to conference committee. Then both houses must vote again. Then the Governor gets out his veto pen and slices and dices (down to the individual-word level). 'Taint over till it's over. But the general movement is forward.

Update 6/11: The Assembly Democrats are having to scrape and lobby and appease very hard in order to herd the cats get enough members of their party to vote for the budget bill to pass the thing. They've been drafting amendments yesterday and today, and one of those who apparently got appeased was Rep. Cullen (see update above). There has been an amendment to the autism provision, brought by one of the authors of AB15 (Rep. Kim Hixon) and Rep. Cullen. It looks like the only change is the dollar figures: $50,000 per year for intensive therapy (down from $60,000) and $25,000 per year for post-intensive (down from $30,000). My understanding is that $50,000 is more in line with what most states are doing; $60,000 would have been the highest of any state, if I understand correctly. So I'm OK with this.

Update 6/4: Hmm, here's a wrinkle. Apparently Assembly Rep. David Cullen (D-Monona), who chairs the Assembly Insurance committee, is outspokenly unhappy that the autism insurance bill was pulled from his committee's purview and included in the budget instead. During his committee's public hearing, Cullen openly chided the Republican committee members for badgering the people who were testifying: "Why are you doing this? We have the votes." Unfortunately, he seems to have changed his tune somewhere along the line, and though he says they were working on a compromise, there sure didn't seem to be a lot of movement. If you can't get your committee members of your own party to work together, then you shouldn't be too surprised when the clock runs out and the measure gets moved to another venue...

Links to prior related posts:
5/29/2009: Wisconsin Autism Insurance -- Excellent News!
3/15/2009: WI Assembly Hearing on 2009 Autism Insurance Bill AB15
2/7/2009: More About Wisconsin Autism Insurance Legislation
1/11/2009: 2009 WI Senate Bill 3

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