Some immediate answers about the NJ insurance bill, A2238:
1. What companies are required to comply with the bill?
The bill will not affect insurance companies, and hence their programs, that are governed by ERISA, a special federal law. This is the main reason that Autism Votes and others are still pushing for a federal bill in addition to the various state laws. Many NJ residents will not receive the benefits of this bill directly.
Here’s a quote from Leslie Long of Autism NJ:
The law, which takes effect in February, will not apply to everyone. Only insurance companies regulated by the state, such as Horizon Blue Cross/Blue Shield of New Jersey (the largest insurer in the state), and state and local government plans must comply.
2. When will it take effect?
The NJ bill states that it “shall take effect on the 180th day after enactment.” By my count, that’s February 9, 2010.
3. What is actually covered?
The bill requires coverage behavioral therapy for those aged 3-21 diagnosed with autism.
The bill requires speech, physical therapy, and occupational therapy for those diagnosed with autism.
4. What is required for treatment?
The other requirement identified in the bill is a “treatment plan” from a physician.
What are we still investigating?
- I will be contacting the state insurance and healthcare regulators to identify the list of companies that should be subject to the new bill.
- I will then be contacting these companies to determine what their plans are in terms of either complying earlier than the 180 days or in terms of requirements for coverage under the plan that are not specified in the statute.
- I will be contacting a number of developmental pediatricians to determine whether they are aware of the treatment plan requirement or have plans for learning what is required.
- I will be contacting the various advocacy groups, including Autism NJ”s Public Policy group and Autism Votes (the NJ page), to learn more about their statutory drafting work as well as the experience in other states with similar statutes.
Finally, in a future post, I’ll do a walkthrough of the bill to help you understand what to expect and what questions you should be asking.