Mandate to require insurance coverage of autism treatment hits Utah Legislature, inspires families

Published: Thursday, Feb. 7 2013 8:00 p.m. MST

Janice Crosby coaxes her son, Cameron, who has autism, off the bus as he arrives home from school in Murray on Thursday, Feb. 7, 2013.

Ravell Call, Deseret News

SALT LAKE CITY — Utah has the highest prevalence of autism spectrum disorder in the nation, yet it remains one of 18 states yet to require insurance plans to cover treatment for the condition.

It is something Sen. Brian Shiozawa, R-Cottonwood Heights, intends to change.

Shiozawa introduced a bill Thursday that would include autism spectrum disorder in the state insurance code, requiring health benefit plans to cover up to $50,000 annually for a child with autism who is younger than 9 years old and up to $25,000 for children ages 9 to 18 for treatment of the condition, which envelops a range of pervasive developmental disorders.

The treatment he wants included in the mandate includes Applied Behavior Analysis and Early Intensive Behavioral Intervention, both of which have proven to have an effective window when children are most likely to successfully respond.

"If you treat autism with evidence-based therapy, there will be positive evidence of improvement, and these children who are intelligence-challenged, cognitively challenged or socially challenged will show demonstrative improvement," said Shiozawa, a St. Mark's Hospital emergency department physician and newly elected senator.

"This is one of the most significant bills you will face this session," he told lawmakers during a presentation of SB55 to the Senate Business and Labor Committee. "It is an opportunity for us to make great medical changes in people's lives."

A Murray mother of four, including two autistic sons, said the provision would be welcomed with open arms.

Janice Crosby has had to learn to navigate medical care and insurance coverage for her sons, Shane, 21, and Cameron, 14. Each exhibits varying degrees of the condition and needs individualized care.

"We're honest people, and we want to be honest with the insurance company," Crosby said, "but you have to have real conversations with doctors and others involved in order to get help to pay for what they need."

Shane has endured seizures for many years, perhaps unrelated to his autism, and he also required a cornea transplant that may have happened with or without his spectrum diagnosis.

Dental treatment is another story. The family has to plan months in advance to be able to cover the costs for both boys because insurance often will deny anesthesia that the boys need but can only be offered in a hospital setting.

"The hardest thing for me, I think, with autism is that while school is great, they're never going to be able to use the academics," Crosby said. "I'd love for them to have an opportunity to work mainly on life skills, to teach themselves to get dressed, to brush their teeth, take a bath and put their shoes on the right feet."

Treatment that involves basic skills training, when it is applied at the appropriate times, Shiozawa said, can ultimately "save millions (of dollars) down the road on suffering and delinquency, the intangible benefits to families and society."

The U.S. Centers for Disease Control and Prevention estimates there are more than 18,500 Utah children with autism, or one in 47, according to a 2008 survey, although the numbers are expected to have grown since then.

"If we treat this now, and not let them languish or go backward, the benefits are going to be huge downstream," Shiozawa said, adding that not all kids, depending on the severity of their condition, would reap the benefits of treatment.

He encouraged colleagues to vote for his bill, as treatment of any kind isn't withheld from children who have diabetes, AIDS or cancer, among others.

As a physician, Shiozawa said the efficacy of treatment for any condition isn't guaranteed, but "we always hold out hope, even in single-digit percentages, that they will get better, but we do not deny them treatment."

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