Will Utah, with one of the nation's highest rates of autism spectrum disorders, join the majority of states that mandate insurance coverage for its treatment?
On Friday, freshman Sen. Brian Shiozawa, R-Cottonwood Heights and past president of the Utah Medical Association, released SB55, which would require health insurance plans to cover autism treatment.
If passed, Utah would join 32 other states that require insurance coverage, according to the national advocacy group Autism Speaks, which endorsed the bill.
That's a big "if." Utah's autism community has been trying for years to mandate coverage, but last year saw their efforts stymied by a bill that instead created three pilot programs treating about 300 children under the age of 6.
Shiozawa, an emergency physician, was unavailable for immediate comment Friday.
But Mirella Petersen, president of Utah Autism Coalition, which is pushing for insurance coverage, said the senator recognizes "we're in a triage situation. We can't do much about it [autism] if we're not going to offer effective, early treatment."
The bill requires coverage of the diagnosis and treatment of autism, including speech, occupational and physical therapy, along with applied behavior analysis (ABA) for up to $50,000 a year for children under age 9 and $25,000 for children ages 9 to 18.
Coverage would start July 1.
ABA therapists charge about $50 an hour, and studies show intensive therapy, or 25 to 40 hours a week, results in the most gains.
Autism Speaks, which helps advocates across the country seek insurance legislation, commended Shiozawa in a statement. It called on Utah to "join the growing majority of states that have ended health care discrimination against children with autism."
The bill wouldn't affect self-insured companies. And small employers could seek a waiver from the requirement if they can prove the cost of coverage increased premiums by at least 2.5 percent in a year.
Last year, insurers and the Salt Lake Chamber of Commerce argued against various proposed mandates, saying extra coverage requirements result in higher insurance premiums for small business owners, some of whom may choose to stop offering health benefits.
On Friday, SelectHealth spokesman Spencer Sutherland said the company has not yet reviewed SB55.
Citing Autism Speaks research, Petersen said autism coverage increases member's premiums an average of 31 cents per member, per month. Still, she anticipates a fight by insurance companies.
"They'll spend more money fighting it than they will actually covering it," she said.
To fight for the bill, the Utah group plans to mobilize the thousands of families across the state affected by the disorder, which is marked by impaired social and communication skills.
The push for the mandate signals a dissatisfaction with the state's current method: covering 315 children through three pilot programs. The pilots serve children ages 2 to 6. Parents who sought treatment in the largest pilot, through Medicaid, were chosen through a lottery. That program has yet to start treating children.
The lack of insurance can not only delay therapy, it can also affect coverage of non-autism related medical needs. Families tell of being denied coverage for wellness visits if their physicians note that the child has autism when submitting the claims.
Petersen said the pilots will be treating so few children that results would not be statistically significant.
"We've got 18,532 children in the state of Utah that have autism. … There's no reason to wait when we have that many families in need," she said.
A recent federal study said 1 in 47 children in Utah have autism, compared to 1 in 88 nationally.
P SB55 is scheduled to be discussed Monday at 4 p.m. in the Senate Business and Labor Standing Committee, room 215 of the Senate Building.