ABA and Insurance in Oregon
In November, Kaiser Permanente issued a statement saying it is now providing ABA services for members with a medical need.
Tobi Rates is the executive director of the Autism Society of Oregon. She says it was welcome news, "We applaud it," she said. "We're thrilled about it. We want the other insurance companies to follow along."
The state has two laws that she says should require insurers to cover ABA therapy -- the 'Mental Health Parity Act' and the' 'Developmental Disabilities Act.'
But she says, there's a catch, "Between those two, it says if you're covering mental health issues, you have to include developmental disabilities, and that includes autism. It doesn't specifically say how you have to cover the autism therapies or what therapies you have to cover."
Hence the current situation where some companies cover ABA, while other's don't.
Kaiser did not make anybody available for an interview with OPB. But the problem for the company now is that if other insurers don't also start offering coverage, Kaiser could end up attracting lots of expensive new customers with autism. That would drive up their costs.
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The Oregon Insurance Division is thinking about it. Spokeswoman Cheryl Martinis says the division is seeking advice from attorneys at the Department of Justice, "We've asked them whether ABA therapy is required under current Oregon law, and if so, under what circumstances. ... So we're awaiting some guidance."
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State Senator Alan Bates, a doctor from Medford, is working on a bill that would create a certification system for ABA therapists. It would also get ABA included in insurance coverage, and establish which children should receive the therapy.
He says it's understandable why insurance companies want a certification process, "A lot of the work is something it doesn't take a lot of education for, but takes a lot of time and you don't want to be paying someone $100 an hour for doing something that could be done for $15 an hour with the same outcome."
He says if a bill is to pass, he needs parents and insurance companies to come to some agreement.
If they don't, he says, he won't take a proposal to the floor because it simply wouldn't survive.
