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Mandated autism care coverage mulled

April 22, 2014 - 12:05am

HONOLULU — For Gerilyn Pinnow, every dollar that goes to treat her son’s autism is one less she’s able to save for her daughter’s college education.

That choice is one reason Pinnow and other parents are pushing the Hawaii Legislature to pass a bill that would require insurance companies to cover treatments for autism, a move opposed by some insurers, who say it could lead to higher costs for people seeking coverage.

The bill is named after Pinnow’s 12-year-old son, Luke, who was diagnosed with autism at the Mayo Clinic in Minnesota.

Traveling to get Luke diagnosed cost the family about $10,000, she said. Pinnow, a teacher who lives in Ewa Beach, said she had to tap into her retirement and short-sell her family’s house to cover treatment costs.

“No other family should have to go through that,” she said in an interview Monday.

Hawaii lawmakers continue to work out the details of Senate Bill 2054, which would require insurance companies to cover applied behavioral analysis and other treatment options. Applied behavioral analysis is widely viewed as the most effective treatment for autism spectrum disorders.

But the Hawaii Medical Services Association, one of the state’s largest insurance companies, opposed the bill, saying it would be too expensive to provide the services.

Jennifer Diesman, vice president of government relations for the company, said in written testimony that a previous audit estimated it would cost $1 billion for Hawaii companies to provide treatment. Instead, Hawaii Medical Services Association asked for a cost study and informed the Legislature that its insurance plans would have to undergo a price adjustment if the bill passed.

“The Legislature should not adopt legislation mandating this coverage until it fully understands its financial impact,” Diesman said. She declined to comment further.

Kaiser Permanente Hawaii also expressed concerns about the bill to lawmakers.

Nationwide, one in 68 children has been diagnosed with an autism spectrum disorder, according to the Centers for Disease Control and Prevention. Hawaii is behind 36 states that already have mandated health care coverage for autism treatment.

Lawmakers in the House and Senate have passed different versions of the bill. They are now debating an age limit for children who would receive mandated treatment and an annual or lifetime cap.

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