TALLAHASSEE, Fla. – The Developmental Disabilities Compact workgroup met Tuesday to begin initial discussions about coverage and benefits that private health insurers can offer to persons with developmental disabilities. Florida Deputy Insurance Commissioner Mary Beth Senkewicz chaired the meeting of the workgroup, which comprises primarily representatives of insurance companies and HMOs.
Near the meeting’s conclusion, Deputy Commissioner Senkewicz charged the group with drafting specific proposals by Nov. 10 for coverage their companies will offer to developmentally disabled persons. The draft proposals will serve as foundation for a more comprehensive discussion of possible benefits at the group’s next meeting, Nov. 20.
“Today we laid the foundation for a closer look at specific benefit options the insurers can provide for developmentally disabled persons,” said Deputy Commissioner Senkewicz. “I am extremely grateful to the companies for their initial thoughts and to Floridians with developmentally disabled children who took time to come tell us their stories.”
Much of Tuesday’s discussion centered on whether applied behavioral analysis should be considered a reasonable and necessary treatment for a developmentally disabled person.
“Behavioral analysis is an often used treatment for developmentally disabled patients, but insurance companies often exclude it from coverage, classifying it as ‘experimental,’ or excluding it because it is not provided by a doctor or nurse,” explained Senkewicz.
Some insurers also have made the argument that behavior analysis should be excluded from coverage, because there is no scientific research to support it. A notable exception, though, is behavioral analysis treatment for autism patients, which has been found to be helpful.
According to Florida law (only applicable to large groups), mandated coverage would enable beneficiaries with autism spectrum disorder to have access to up to $36,000 of coverage each year subject to a the lifetime cap of $200,000 for services prescribed by their treating physician. The workgroup is considering expanding coverage to persons with developmental disabilities other than just autism. If no compact is negotiated, the autism mandate will take effect April 1, 2009.
The Developmental Disabilities Compact was established by Senate Bill 2654 and signed into law in May by Gov. Charlie Crist.
Called the "Window of Opportunity Act," Section 624.916, F.S. charged the Office of Insurance Regulation (Office) with developing and executing a compact relating to insurance coverage and access to services for persons with developmental disabilities. The Office also was charged with convening a consumer advisory workgroup to provide a forum for comment on the negotiated compact. That workgroup will meet again soon.