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Update on Autism Spectrum Disorder Bills in the Florida Legislature
Update on Autism Spectrum Disorder Bills in the
Update (April 28, 2008 7:00 PM)
Nothing new today that I have seen or heard - other than rumors.
Summary (April 25, 2008 2:00 PM)
Many people want to know more about what is going on in the
The Senate passed its bill. The House bill has not yet made it to the floor of the House and time is running out for action in 2008. FYI:
- The
- During the session, the House and Senate much each pass their bills and then negotiate and agree on compromise legislation.
- For those who do not know and want some insight into the complexities of the process, the Florida House has posted: How A Bill Becomes Law (Explanation) and How a Bill Becomes a Law (Chart))
- Just for fun, you may have seen this: Schoolhouse Rock- How a Bill Becomes a Law
The original House bill was very similar to bill passed by the Senate. On April 4th, Speaker Rubio encouraged a broader approach and appointed a Select Committee to study alternatives. The Special Committee approved a substitute bill which it forwarded to the Healthcare Council. The Healthcare Council approved the substitute bill at its meeting on this week (April 22nd). During that meeting, Speaker Rubio told the Healthcare Council not to worry about having the time to address the recommended changes (see summary below and this article) or having the funds necessary to implement those changes. The Healthcare Council has not yet forwarded the bill to the full House. The Healthcare Council indicated that discussions would be ongoing through the week and weekend before submission to the House next week. It was suggested during the meeting that negotiations were ongoing with the Senate.
If the House and Senate agree on one bill, they must submit the legislation to the Governor for his signature. Governor Crist has spoken favorably about such insurance mandates (click here) and about the Senate legislation (click here and click here), but perhaps not the House legislation promoted by Speaker Rubio (click here). Governor Crist formed the Autism Task Force (click here) to address some of the new issues addressed by the substitute House bill. The Governor and Chief Financial Officer Sink disagree about the House bill (click here). FYI, CFO Sink oversees the Department of Financial Services and its 13 divisions, including the Office of Insurance Regulation.
Interestingly, representatives from the Florida Insurance Council and Blue Cross Blue Shield of Florida told sponsors they support the plan approved by the Special Committee and Healthcare Council, while insurance companies generally oppose the Senate bill and insurance mandates generally (click here and click here)
Details: (April 25, 2008 2:00 PM)
· SB 2654 – Relating to Autism Spectrum Disorder
o General Information: click here: bill summary – "Steven A. Geller Autism Coverage Act."
o Last Action Taken in the Senate: Approved 39-0 and sent to the House
· HB 1291 - Autism Spectrum Disorder
o General Information: click here: bill summary – “Window of Opportunity Act”
o Last Action Taken in the House: Healthcare Council 4/22/2008 meeting
§ click here: webcast of 4/22/2008 Healthcare Council meeting: see link “Committee Video Archives” in box at bottom right of web page
§ click here: Summary Analysis and Proposed Bill (4/22/1008)
§ click here: Proposed Committee Bill
· The proposed House bill is now significantly different from the Senate bill, particularly:
o Insurance Coverage Mandate:
§ Amount: Includes the same $36,000 per year coverage mandate, but adds a lifetime limit of $108,000 (per person, per incident)
§ Effective Date: Delays the effective date of coverage mandate from 1/1/2009 until July 2010:
o Alternatives: Offers alternative mechanisms:
§ Insurance:
· Insurance Compact:
o Pending the effective date of the mandate, the bill delegates to a workgroup the legislative responsibility of formulating a solution. The workgroup is to study, propose and approve a compact that can be adopted by an insurance company to avoid the delayed coverage mandate.
o The compact would address penalties for noncompliance, disclosure to consumers, and the development of new insurance products to address such needs
o The workgroup would consist only of insurers, self-insured employers, and designees of the Governor, House and Senate. The Healthcare Council was encouraged to include a citizen representative, but so far has declined.
· Healthy Kids: expands coverage, effective 1/1/2009, by:
o Eliminating existing income cap purportedly making the coverage available to all
o Expanding benefits to include habilitative benefits such as PT, OT, speech therapy, and
· Medicaid: Seeks to expand Medicaid state plan
§ State Education:
· Expands eligibility of McKay scholarships effective for 2012-2013 school year
· Creates VPK program offering early intervention services beginning with the 2012-2013 school year for children with IEP and otherwise eligible for VPK
· Assigns to CARD added responsibilities for establishing regional learning gateways within the seven CARD regions
o Applies to ASD children and children with other defined developmental disabilities
o The Healthcare Council was encouraged, but so far has declined, to:
§ change the name of CARD if responsibilities expand beyond autism
§ consider significant funding increases due to significant expansion of CARD’s responsibilities
§ Medical:
· Addresses expanded continuing education for healthcare professionals to increase ability to identify children with autism spectrum disorders and other developmental disabilities
§ Funding: not yet addressed
§ click here: final Committee Action - reflected here:
· proposed bill passed 18-0
· proposed amendments
§ Listing of all meeting handouts and action packets for Select Committee on Autism & Developmental Disorders
Previous action of interest
· Bill analyses by the Senate:
o Health and Human Services Appropriations Committee (04/10/2008)
o Health Policy Committee (04/03/2008)
o Banking and Insurance Committee (3/18/2008)
· Bill analyses by the House:
o Committee on Health Innovation (4/2/2008)
o Committee on Health Innovation (3/17/2008)
· Select Committee on Autism & Developmental Disorders:
o General Information About the Select Committee: includes meeting handouts and action packets
o Webcasts of Select Committee meetings in April: see links in box at bottom right of web page
o Committee materials handed out at meetings
· Speaker of the House press release announcing Select Committee: summary of Speaker Rubio’s proposals:
o Broaden Scope of Disabilities Covered: “The purview of the committee will be to consider ways to best utilize public and private resources to assist families in Florida with children coping with autism spectrum disorders or other developmental disabilities.”
o Increase Number of Citizens Covered: “While mandatory insurance coverage has been suggested as one solution, it is important to note that more than 50 percent of the health insurance sold in Florida is not subject to state mandates. . . . Policies that are subject to such mandates cover fewer than three million citizens.” This part of the story is complex, but essential to understanding why the Florida House and Senate cannot do more at this time:
§
§ Self-insured plans not subject to mandate: Many employers (typically larger employers who can afford it) self-insure the risk of their health plans. In these cases, insurance companies only administer the plans. Most employees are not aware of the difference. It is also difficult to ask the employer to confirm self-insurance without giving up privacy rights regarding existing medical conditions and risking lost coverage for otherwise covered costs.
§ Fewer than 50% covered by mandates: Studies have shown that, overall, 45 percent of workers were covered by fully insured health plans and 55 percent were covered by self-insured health plans (see EBRI February 2008 Issue Brief). It is not clear what portion of the 45% of insured plans is also not covered by either the FL Senate or the FL House bills. Both bills specifically exclude insurance carried by health plans of small employers (undefined) or individual insurance.
§ ERISA Preemption Explanation: ERISA is a federal law that was initially proposed to protect beneficiaries of employer sponsored pension plans. The law was drafted much more broadly to cover all employer sponsored benefit plans, including health care plans, with a goal of seeking uniformity in the administration of plans by employers.
· A good summary of dilemma created by ERISA preemption is included on pages 22-24 of a summary (click here) of a US House mental health parity bill (H.R. 1424):
o “Understandably, large employers who operate in multiple states prefer a single unified system—with one set of rules with which they must comply and treat their employees. . . . The employer community has used the Employee Retirement Income Security Act (ERISA) as a shield against both federal and state health care protections.
o “Only the most sophisticated legal and health care experts know that ERISA contains few health care standards. ERISA is primarily a pension law that establishes detailed standards for information, coverage, and funding of pension promises. While ERISA applies to all employer provided employee benefits, it does not generally contain minimum health care standards. Enacted in 1974, Congress expected that it would shortly adopt comprehensive federal standards. Congress has attempted to enact national health care standards on several occasions, but without success.”
o “Further complicating the issue is the illogical treatment of ‘insured’ versus ‘self-insured’ plans. Under current judicial interpretation of ERISA, if an employer establishes a health plan and the employer is the insurer of the plan, then the states are generally preempted from regulating the health plan. However, if the employer contracts with a state licensed insurance company or other state sanctioned health care entity, then the state may directly regulate the behavior of the insurer or other entity, and indirectly affect the actions of the health plan. Despite the illogic of this regulatory scheme, in the absence of broader Congressional direction on comprehensive health care reform, H.R. 1424 continues this existing system of split federal versus state oversight of health plans and benefits.
· Generally, insurance companies and employers favor ERISA preemption (for example, ERIC fights to preserve the ERISA preemption)
§ Good news pending in DC: More interestingly, H.R. 1424 includes provisions to weaken ERISA preemption:
· Mental health parity bills typically apply to children with autism spectrum disorders because ASD is considered a mental illness under the Diagnostic and Statistical Manual of Mental Disorders DSM -IV-TR (fourth edition, text revision
· H.R. 1424 passed in the US House and was submitted to US Senate
· The US House bill currently in conference committee to address differences from Senate bill S.358 - apparently the conference committee may be close to reaching a compromise on the bill and the preemption provision may survive.
o Avoid Costly Mandates: “A costly mandate could jeopardize the ability of many to maintain their insurance.”
o Public Education Based Solutions: “
Richard Probert: husband of Debra Kaszovitz and father of twins born prematurely in 2004 after only 25 weeks, Jack (diagnosed with ASD) and Samantha: probert_richard@yahoo.com
Update (April 29, 2008 11:00 AM)
The articles below reflect the general perception that, because the House and Senate are now each pushing very different bills, the end result is likely to be no bill at all. The Senate bill has not budget impact, while the price tag for the House bill is estimated to be over $100 million. In a year of severe budget cuts, it appears unlikely at this point in the session that a bill that impacts the budget will pass in the House or Senate, regardless of the good intentions behind the bill and strong support for the perceived benefits.
Autism Speaks believes that it is important that as many citizens as possible send a strong message of support to members of the Senate and House in favor of the Senate version of the bill. Through its Autism Votes initiative, Autism Speaks is urging Florida residents to Take Action in Florida: Call and Email House Speaker Marco Rubio and Urge Him to Bring up SB 2654 for an Immediate Vote in the House Without Amendment!!
Articles:
House members are determined to have that bill preserved, even with its estimated price tag of upwards of $100 million and no money in the budget, said Sen. Steve Geller,
"I'm no longer hopeful for any bill passing," Geller said. "They want everything included. They're loving it to death," meaning it's loaded with so many good-sounding things that it becomes impractical, or too expensive, to gain approval.
"I'd love to do something for all disabled children, but the costs make it prohibitive," Geller said.
· Articles:
State House leaders acknowledged Monday that the state doesn’t have the money to have Medicaid and Healthy Kids cover all
Instead, the House wants to “put a mechanism in place” to have autistic kids get coverage through Healthy Kids whenever the money becomes available.
o Insurers must cover autism, says Crist
· Editorial: Require autism coverage
The goal of House Bill 1291 and Senate Bill 2654 is the same: to provide health insurance coverage for children with autism. But neither bill would fully accomplish what is in the best interest of the estimated 10,000 autistic children in
The News-Press: Crist favors Florida Senate version of autism insurance bill –
Crist said he favors the Senate's approach, in a bill by Sen. Steve Geller,
Geller himself has praised the House plan for its efforts, but said the price tag could make it impractical. It also sets up a scenario of having poor children competing with disabled children for a limited number of coverage slots in Healthy Kids.
Herald Tribune: Crist wants to pass gas tax, autism mandate
news-press.com: Crist favors Florida Senate version of autism insurance bill
sun-sentinel.com (The Associated Press): Bills would increase insurance aid for autism therapy
I agree with Kidzdriver, that is very well laid out. I also read the article that Probert posted about Sharon Boyd and her struggles. All incredibly frustrating and true stories for many of us parents, especially those with limited incomes. I would ask ANY family to add an additional expense of $200-$400 of weekly therapy services (not paid for by our insurance companies) and see how their budget stacks up. It's practically impossible. Something has to give.
Everyone please make sure that you let your senators know that this is incredibly important.
Thanks.
No, I'm not part of the legislature. I'm just an interested parent.
I hope everyone finds the posts useful. I wish I could do more.
Richard
Update (April 30, 2008 10:00 AM)
The House passed amendments to the Senate Bill late last night. To read the amendments, click here (61 pages). The House plans to debate the amended Senate bill this morning. To watch the House session live click here or click here - no scheduled time.
The House will then send the amended Senate bill back to the Senate for further debate. As you can see form the articles below, that debate should be interesting. To watch the Senate session live click here or click here - no scheduled time.
Articles:
House Speaker Marco Rubio is "swinging for the fences" when it comes to his health insurance agenda, vowing Tuesday that he will negotiate all night, every night if needed to pass his version of legislation to cover children with certain developmental disabilities. . . . Rubio denied taking an all-or-nothing approach, but said that he isn't willing to settle for anything short of "meaningful and comprehensive" reform.
Steve Geller, sponsor of a leaner Senate version, complimented Rubio's passion for the issue but said his approach is likely to backfire. "I believe that they are more likely than not killing the bill and making sure no one gets anything," said Geller, Senate minority leader from
news-press.com: Florida House leaders take stand on autism insurance coverage bill
“These are the options, to do a little or do it right,” House Speaker Marco Rubio said. “We want to do something meaningful and comprehensive. Anything less is a disservice.”
The standoff is likely to mean no bill at all, Geller said.
Richard
The House is addressing the legislation now - 2:15pm.
To watch the House session live click here or click here.
Update (April 30, 2008 2:30 PM)
Senate bill as amended by the House passed 117-0 with no debate. The action shifts to the Senate - no schedule. To watch the Senate session live, click here or click here.
Richard
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
· 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
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
· 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.
§