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Authorizing the Committee on the Disabled & Persons with Special Needs to hold hearings regarding Pennsylvania Autism Insurance Act of 2008.
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WHEREAS, Autism, also known as Autism Spectrum Disorder (“ASD”), is a complex neurological disorder that affects, in varying degrees, language and social skill development, characterized by challenges in communication and social interactions, repetitive behaviors and movement, impacting individuals of all racial, ethnic, and socioeconomic backgrounds; and
WHEREAS, Prior to the Pennsylvania Autism Insurance Act of 2008 ("Act 62"), because private health insurers usually did not cover Autism services, almost all Pennsylvania children with Autism received coverage for Autism services exclusively through Pennsylvania's Medical Assistance (also known as Medicaid) program; and
WHEREAS, Then-Speaker of the Pennsylvania House of Representatives Denny O’Brien championed the state’s first-ever Autism insurance legislation, which included the ASD Coverage provision in Pennsylvania’s insurance law, requiring private insurers to provide coverage for essential treatments for individuals with Autism, such as Applied Behavioral Analysis (ABA), and other structured behavioral programs; and
WHEREAS, Act 62 requires private health insurance companies to pay up to $36,000 per year for diagnostic assessments and treatment of covered individuals with ASD who are under age 21, with exceptions for policies that cover fewer than 51 employees or children already covered by Pennsylvania’s Children’s Health Insurance Program; and
WHEREAS, Act 62 covers any form of ASD identified in the most recent edition of the Diagnostic and Statistical Manual – currently including Autistic Disorder, Rett Syndrome, Pervasive Developmental Disorder NOS (Not Otherwise Specified), Childhood Disintegration Disorder, and Asperger's Disorder – not necessarily services for a child with a "primary" diagnosis of ASD; and
WHEREAS, Act 62 mandates that private insurance companies pay for covered children to receive diagnostic assessment services, which are medically necessary assessments, evaluations, or tests by a licensed physician, licensed physician's assistant, licensed psychologist, or certified registered nurse practitioner to diagnose whether a child has an ASD; and
WHEREAS, Specified categories of care include: psychiatric; psychological; rehabilitative, including applied behavioral analysis; therapeutic, including speech therapy, occupational therapy, and physical therapy; and pharmacy; and
WHEREAS, Act 62 requires private insurance companies to pay for autism services by specified qualified professionals -- licensed physicians, licensed physician assistants, licensed psychologists, licensed clinical social workers, certified registered nurse practitioners, and those who work under such professionals' direction; and
WHEREAS, These legal requirements provide critical protections to people with Autism, their families, and their service providers; now, therefore, be it
RESOLVED, BY THE COUNCIL OF THE CITY OF PHILADELPHIA, That Council does hereby authorize the Committee on the Disabled & Persons with Special Needs to hold hearings regarding Pennsylvania Act 62 of 2008.
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