DCI News

Jefferson City, Mo. - A new report from the Missouri Department of Insurance shows that the number of individuals treated for autism-related conditions increased by more than 22 percent last year. In 2012, the number of individuals receiving treatment was 2,508 while in 2013 that number increased to 3,070. 

A 2010 law, signed by Gov. Jay Nixon, requires health insurance companies to cover specific autism therapies, including applied behavior analysis (ABA). The department's report says autism treatments have increased more than 92.3 percent since 2011. 

Using data supplied by health insurance companies, the report says insurance claims for autism-related treatments totaled $8.2 million in 2013. That figure is 26.6 percent higher than claims paid in 2012. Still, the number accounts for a small fraction - just 2/10 of 1 percent - of the over $4 billion in health claims paid by Missouri health insurers during 2013.

The number of licensed professionals providing ABA treatment continues to grow, with over 200 providers currently licensed in Missouri.  As a result of greater access to this treatment, payments for applied behavior analysis jumped 264.4 percent from 2011 to 2013.  However, the impact on overall health insurance costs remains minimal. In 2013, the average policyholder seeking ABA treatment received $1,704 in autism services, just 4.3 percent of the annual maximum benefit.

"Missouri's landmark autism insurance law continues to deliver benefits for families impacted by autism," said John M. Huff, director of the Missouri Department of Insurance. "Especially encouraging is the continued low impact on overall health insurance claims."

Missouri law does not require health insurance companies to submit their rates to the Department of Insurance, but Huff says the overall claims numbers suggest minimal, if any, impact on the premiums consumers pay.

Other noteworthy findings from the department's report:

• Across all market segments, the average per member, per month (PMPM) cost in 2013 for all autism-related claims was $0.48 and was just $0.22 for ABA treatments.
• More than 1.3 million individuals received coverage from a licensed insurer. Adding public employees and other self-insured entities, the DIFP estimates that as many as 1.6 million individuals have benefited from the autism mandate.
• All policyholders in the large- and small-group markets now have insurance coverage for autism treatments.
• The law allows insurers in the individual market to offer autism coverage as an extra, with an added cost. Some companies offer it as a standard provision in every policy. As a result, about one-third of consumers enrolled in the individual market have this coverage.

The law originally required health insurance companies to cover $40,000 for applied behavior analysis therapy per policyholder, to be adjusted yearly by the director of the Department of Insurance using the Consumer Price Index. The maximum benefit for this year is $42,734, subject to medical need.

The Department of Insurance has extensive resources for families and health care providers on its website. Consumers and providers with complaints or questions are encouraged to call the department's Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.