Update on Autism Spectrum Disorder Bills in the Florida Legislature (May 2, 2008 2:00 PM)

Update (May 2, 2008 2:00 PM)

Today is the last day of the 2008 regular session. 

Just before noon, the Senate further amended the House bill by a 40-0 vote with no debate.  In the pre-session, Senate President Pruitt indicated that the budget, Cover Florida, and the autism bill were their top priorities today.  After an hour and a half, the Senate addressed the bill.  Senator Geller, sponsor of original Senate bill, complimented the house for their efforts, discussed the reasons why the Senate could not accept the broad changes to the Senate bill adopted by the House, and essentially went back to the Senate bill with few of the changes proposed by the House:

·         He complimented the House on their passion and indicated his appreciation for their efforts to address children with other developmental disabilities

·         Estimated 10 times more children would be covered after the House changes, but expressed concern that there was no examination by the Senate of the estimated cost impact to the State of Florida – which he estimated would be dramatic

·         Indicated that the efforts to address developmental disabilities must start with autism and that, next year, the Senate and House should start early in the session to address additional needs of children with developmental disabilities

·         Noted that the original Senate bill was an insurance mandate (with annual but no lifetime benefit limitations) to provide to children who have autism spectrum disorders critically necessary therapies, specifically including ABA which he noted was the state of the art therapy

o        He referred to studies that indicated that limiting the mandate to autism would increase premiums only ¼ to ½ of 1% (0.26% to 0.47%)

·         Expressed an intent to compromise with the House by accepting provisions in the proposed House amendments that had no immediate fiscal impact or would have a fiscal impact in the future without further study by the Senate, which resulted in these provisions:

o        Insurance mandate: including these features:

§         Covers employer-sponsored, health benefit plans purchasing insurance policies and HMO contracts, but not,

·         ERISA preemption: Does not cover self-insured, employer-sponsored, health benefit plans. As I explained in this forum earlier this week, the bill cannot cover these plans because of the federal law (ERISA) that prohibits state law mandates that address what an employer-sponsored, health benefit plan must cover.  If such a plan chooses to buy insurance for employees in Florida, they must buy insurance that includes the mandated coverage.  If they choose to self insure, today, the State of Florida can mandate no aspects of that plan.  Nationwide, approximately 55% of such plans are self-insured.

·         Small insurance pools: Does not cover insurance plans offered in the individual market, individually underwritten insurance plans, or insurance plans provided to a small employer (not defined).

·         House members have stated in session that the combined effect of these exceptions is that only 13% of children in the state with developmental disabilities would be impacted by this insurance mandate.  I do not know the source of this conclusion, which indicates that the small insurance pools exception and the uninsured population would include 33% of children with developmental disabilities.

§         Covers insurance plans issued or renewed on or after April 1, 2009

§         Added a $200,000 lifetime cap for autism related benefits rather than the $108,000 limits proposed by the House – acknowledging the need for 3-4 years of intense ABA and other therapies

o        Insurance compact: as proposed by the House, including these features:

§         Must convene, by August 31, 2008, a workgroup to address a binding insurance mandate agreement that includes a representative of all health insurers, a representative of all HMOs, a representative of employers with self-insured health benefit plans (which are not bound to accept the compact), a representative of the House, a representative of the Senate, and two representatives of the governor, including a consumer advocate (the Senate added this advocate). 

§         The insurance mandate excludes any insurance company that signs this compact.

o        Medicaid: Seeks to expand the Medicaid state plan, as proposed by the House, including coverage for autism spectrum disorder and Down syndrome and annual coverage limits of $36,000 and lifetime benefit limits of $108,000.

o        Excludes all other features of the proposed House amendments, which he estimated would cost the State of Florida at least $100 million.  Excluded features include:

§         VPK changes

§         Healthy Kids coverage

§         Expanded eligibility of McKay scholarships

§         Continuing education for healthcare professionals to increase ability to identify children with autism spectrum disorders and other developmental disabilities

The action now shifts back to the House - no scheduled time.  Currently, they are honoring Speaker Rubio rather than addressing legislation.  Both the House and Senate have spent a number of hours this week doing that.  To watch the House session live, click here or click here.  To watch the Senate session live, click here or click here.