Autism Insurance Mandate
Spearheaded by legislative champion, Speaker Joseph Roberts, Jr., Autism New Jersey played a critical role in the passage of P.L. 2009 c. 115 Health Benefits Coverage for Autism and Other Developmental Disabilities in 2009. Later that year, Autism New Jersey worked with the Department of Banking and Insurance (DOBI) to provide technical assistance on provider qualifications for ABA services. In early 2010, DOBI issued a bulletin to provide implementation guidance to carriers, families, behavior analysts, and other providers. The autism insurance mandate went into effect on February 9, 2010.
Since 2010, Autism New Jersey has provided information and outreach to increase families’ access to reimbursable services. These efforts include web-based and in-person trainings across the state and Maximizing Coverage Under the New Jersey Autism & Other Developmental Disabilities Mandate, a booklet that describes covered services and how to navigate the process with providers, insurance carriers, and DOBI.
Addressing Implementation Concerns
We are encouraged that some families have accessed these benefits and their children are making meaningful progress as a result. However, there have also been obstacles to coverage for many families. The New Jersey State Assembly Financial Institutions and Insurance Committee, chaired by Assemblyman Gary Schaer, responded to these concerns by holding a hearing on March 7, 2013. Autism New Jersey provided testimony [link to testimony from 2013 news archive] that identified challenges for families, providers, and carriers alike. Given the additional and detailed testimony provided by parents, Chairman Schaer directed all relevant stakeholders to work together in an effort to increase access to reimbursable services as the law intended.
Immediately following the hearing, Autism New Jersey, Autism Speaks, and attorney Jodi Bouer began authoring a report that outlined the autism and provider communities’ concerns. This report served as the basis for a meeting that occurred on September 16, 2013. Autism New Jersey hosted the meeting attended by parents, providers, DOBI, the New Jersey Association of Health Plans, Aetna, AmeriHealth, Horizon, United Healthcare, and the New Jersey Association for Behavior Analysis. Following an overview of challenges experienced by parents and providers, DOBI emphasized legal requirements and its commitment to investigating violations of the law. The carriers stated their motivation to address individual and systemic challenges. Overall, the stakeholder group had a productive initial dialogue and will be addressing pivotal issues such as coding, provider credentialing, network adequacy, claims processing and authorization, and utilization management.
Given the depth of our knowledge and the relationships we have established to effect change, we welcome your questions regarding insurance coverage and are here to help parents and providers navigate the entire process. Call Autism New Jersey at 800.4.AUTISM or email us at email@example.com. Please also visit the Department of Banking and Insurance’s website to learn more: http://www.state.nj.us/dobi/consumer.htm
Pictured above are parents, providers, and representatives from Aetna, Autism New Jersey, Autism Speaks, Horizon, New Jersey Association of Health Plans, New Jersey Association for Behavior Analysis, New Jersey Department of Banking and Insurance, and United Healthcare
Front Row (L to R): John Leyman (Horizon), Daniel Unumb (Autism Speaks), Suzanne Buchanan (Autism New Jersey), Bobbie Gallagher (Autism Center for Educational Services), Ellen DeRosa (New Jersey Department of Banking and Insurance)
Back Row (L to R): Deb Charette (Autism New Jersey), Craig Domanski (The Data Group), Sarah McLallen (New Jersey Association of Health Plans), Larry Lewis, Jr. (Aetna), Kathleen McCabe-Odri (New Jersey Association for Behavior Analysis), Meredith Goldstein (parent), Ward Sanders (New Jersey Association of Health Plans), Elena Graziosi (Autism New Jersey), Lisa Levine (United Healthcare), Assistant Commissioner Neil Sullivan (New Jersey Department of Banking and Insurance), and Cort Adelman (Horizon). (Not pictured: Erin Luber, AmeriHealth)