[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
MODEL AUTISM INSURANCE ACT
A. A health insurance policy will provide coverage for the diagnosis of autism spectrum disorders and the treatment of autism spectrum disorders in individuals less than twenty-one years of age. To the extent that the diagnosis of autism spectrum disorders and the treatment of autism spectrum disorders are not already covered by a health insurance policy, coverage under this section will be included in health insurance policies that are delivered, executed, issued, amended, adjusted, or renewed on or after XX days from the effective date of this section. No insurer can terminate coverage, or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with one of theautism spectrum disorders or has received treatment for autism spectrum disorders.
B. Coverage under this section will not be subject to any limits on the number of visits an individual may make to an autism services provider.
C. Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of a health insurance policy to the extent that other medical services covered by the health insurance policy are subject to these provisions.
D. This section will not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.
E. Coverage under this section will be subject to a maximum benefit of $XX,XXX per year[benefit limit should be between $36,000 and $50,000]. After December 31, 20XX, the insurance commissioner will, on an annual basis, adjust the maximum benefit for inflation by using the Medical Care Component of the United States Department of Labor Consumer Price Index for all urban consumers (CPI-U). The commissioner will submit the adjusted maximum benefit for publication annually no later than Month X of each calendar year, and the published adjusted maximum benefit will be applicable in the following calendar year to health insurance policies subject to this act. Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, service, or item unrelated to autism spectrum disorders will not be applied towards any maximum benefit established under this section.
[OPTIONAL: Strike paragraph E and leave benefit uncapped.]
F. This section will [will not] apply to the following types of policies [specify types of policies].
G. As used in this section:
1. “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relations between environment and behavior.
2. “Autism services provider” means any person, entity, or group that provides treatment of autism spectrum disorders.
3. “Autism spectrum disorders” means any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.
4. “Diagnosis of autism spectrum disorders” means medically necessary assessment, evaluations, or tests to diagnose whether an individual has one of the autism spectrum disorders.
[OPTIONAL: in the event that 12.f. below is used, add the following definition: “Evidence-based research” means research that applies rigorous, systematic, and objective procedures to obtain valid knowledge relevant to autism spectrum disorders.]
5. “Habilitative or rehabilitative care” means professional, counseling, and guidance services and treatment programs, including applied behavior analysis, that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.
6. “Health insurance policy” means any group health policy or contract issued by an insurance entity subject to one of the following: [cite applicable statutes].
7. “Medically necessary” means any care, treatment, intervention, service, or item that is prescribed, provided, or ordered by a licensed physician or a licensed psychologist in accordance with accepted standards of practice and that will, or is reasonably expected to, do any of the following:
a. prevent the onset of an illness, condition, injury, or disability;
b. reduce or ameliorate the physical, mental, or developmental effects of an illness, condition, injury, or disability; or
c. assist to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the individual and the functional capacities that are appropriate for individuals of the same age.
8. “Pharmacy care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications.
9. “Psychiatric care” means direct or consultative services provided by a psychiatristlicensed in the state in which the psychiatrist practices.
10. “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.
11. “Therapeutic care” means services provided by licensed or certified speech therapists, occupational therapists, or physical therapists.
12. “Treatment for autism spectrum disorders” will include the following care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:
a. habilitative or rehabilitative care;
b. pharmacy care;
c. psychiatric care;
d. psychological care; and
e. therapeutic care.
[OPTIONAL: f. Any care for individuals with autism spectrum disorders that is determined by the state health department, based upon its review of best practices or evidence-based research, may be medically necessary and that is published in the gazette for rulemaking by state agencies. Any such care, treatment, intervention, service, or item that was not previously covered will be included in any health insurance policy delivered, executed, issued, amended, adjusted, or renewed on or after XX days following the date of its publication in the gazette.]
[OPTIONAL: The state health department will promulgate regulations establishing standards for qualified autism services providers. Once the regulations are promulgated, payment for the treatment of autism spectrum disorders covered under this section will only be made to autism services providers who meet the standards.]
H. Except for inpatient services, if an individual is receiving treatment for autism spectrum disorders, an insurer will have the right to request a review of that treatment not more than once every XX months unless the insurer and the individual’s licensed physician or licensed psychologist agrees that a more frequent review is necessary. The cost of obtaining any review will be borne by the insurer.
[OPTIONAL: The state health department will establish standards to be utilized by managed care plans for the credentialing of autism service providers. The department may require that a managed care plan grant credentials to any autism services provider whom the department determines meets or exceeds the department’s credentialing standards.]
I. This act will take effect in XX days.
More With Autism Votes
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.