Mandate Obstacles

Bloomberg Business Week reports on a West Virginia measure:

With the House of Delegates poised to vote Thursday on requiring insurance coverage for autism treatment, West Virginia officials are researching whether the long-sought proposal might run afoul of a 2002 law addressing mental health benefits.

The federal health care overhaul might also come into play, depending on whether its eventual roster of essential benefits includes applied behavioral analysis, or ABA therapy.

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The 2002 law aims to put mental health coverage on par with other medical benefits. But it also allows insurers to limit benefits and take other steps when their spending on mental health exceeds 2 percent of a given plan's total costs.

"It's fair to say we think there is a question as to how this would interface and interact with mental health parity," said Fred Earley, president of Highmark Blue Cross Blue Shield West Virginia.

State Insurance Commissioner Jane Cline said Wednesday that her office is reviewing whether the pending legislation could trigger that law's cost-containment provision. Cline also said that she cannot recall any insurer invoking that provision since the law's enactment.

The federal health care overhaul, meanwhile, would be a factor if it deems ABA therapy as essential but sets a less-generous benefit than what West Virginia may require. The difference would be whether the state would qualify for federal funds to subsidize consumer insurance premiums.

"If the state adopts something that goes beyond that, that will become a cost for the state," Early said. "That's a very uncertain area right now. I don't believe there will be any guidance until at least later this year."

The Council for Affordable Health Care, an industry research group, estimates that mandating this coverage increases premiums by between 1 and 3 percent. Overseeing the state's largest private insurer, Earley considers the House's version the more prudent approach.

While 23 other states already require ABA therapy coverage, at least 17 also limit benefits.