Local Advocates Call Autism Bill a Big Step Forward

Local autism advocates say that while Gov. Jon Corzine’s recent sign-off on legislation that requires state insurers to cover autism treatments was a huge step forward, questions still remain how the law will be implemented.

Corzine’s signature on the bill on Aug. 13 made New Jersey the 15th state to require insurance companies to cover treatments for autism and developmental disabilities for children up to age 21. Previously, insurers denied coverage for many treatments, including speech, physical and behavioral therapies, because they were deemed “academic,” not medical in nature, since the therapy would not cure the life-long condition.

Adrienne Robertiello, a Scotch Plains resident and an autism educator at Children’s Specialized Hospital in Mountainside, said she’s heard a lot of questions floating around about the new law.

“When does it start? What can I ask for? Is my insurance covered? Right now, there’s no authoritative person per se to answer those questions,” she said.

One of the biggest questions many parents have, according to Children's Specialized Hospital Autism Coordinator Jill Harris, is who insurers will approve to provide these therapies.

“With applied behavioral analysis, how are they going to define that?” Harris asked, referring to the popular autism therapy. “The people who probably have the best training to provide that are people who are board certified behavioral analysts. I think it’s great, ABA needs to be provided, but I’m not sure about the nitty gritty of how the legislation will define who can provide it.”

“When services are covered, you need to make sure that the clinician is knowledgeable about autism, and that’s another thing this legislation doesn’t touch,” Harris continued. “Sometimes insurers say somebody’s 'in network,' but when you go you find out that person doesn’t have experience with autism, so it’s a waste of the family’s time and the insurer’s money. It’s not just a question of covering service, but also training the professionals who are delivering the service.”

Another limitation of the legislation is that only families with state-regulated insurance are covered. According to a statement released by Autism New Jersey, one of the state’s largest autism advocacy groups, only insurance companies regulated by the state, such as Horizon Blue Cross/Blue Shield of New Jersey and state and local government plans must comply. Large companies that self-insure or federally regulated plans are not required to provide the coverage.

“I think it’s an important first step for New Jersey for legislation providing better coverage for kids with autism, but not everybody is going to be eligible,” said Harris, who’s also a Scotch Plains resident and the mother of a child with autism. “I think federal legislation that covers all types of insurance is really what’s needed.”

For those families who are eligible, the legislation requires insurance companies to provide up to $36,000 per year for medically-necessary behavioral early intervention.

Robertiello said while she’s grateful for that coverage, she wonders how it will impact the rates insurers charge everyone else.

“That’s a lot of money coming out of insurance,” she said. “Are premiums going to go up? It may not matter to me who’s getting the service, but to my neighbor who’s not, will they be affected?”

Still, for those who will benefit, Robertiello said one cannot underestimate the impact this will have on New Jersey families, in a state where one in 94 children has autism.

“This affects parents in a big way, because previously you may have had two parents with one or more children with autism, and one would have to leave employment because they had to handle all the intricacies of a child with autism. That’s one less salary with insurance not covering most things. Now, with insurers covering it, that will be a huge help for these families,” Robertiello said. “At the end of the day, we think: have we done a sufficient job for our son? But moreover, have we done a sufficient job balancing his needs with those of our two other children? We could have remortgaged our home or sold a ring, but all that money would now be getting away from the quality of life for our other children. Many parents and siblings get the brunt end of it, and for us personally it was a matter every day trying to balance for the whole family.”