Call to Order and Roll Call
The 1st meeting of the Interim Joint Committee on Banking and Insurance was held on Tuesday, June 25, 2013, at 10:00 AM, in Room 149 of the Capitol Annex. Representative Jeff Greer, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Tom Buford, Co-Chair; Representative Jeff Greer, Co-Chair; Senators Jared Carpenter, Julian M. Carroll, Chris Girdler, Morgan McGarvey, Dennis Parrett, Dorsey Ridley, Albert Robinson, Dan "Malano" Seum, and Brandon Smith; Representatives Julie Raque Adams, Dwight D. Butler, Ron Crimm, Joseph M. Fischer, Jim Gooch Jr., Mike Harmon, Dennis Horlander, Thomas Kerr, Adam Koenig, David Meade, Michael Meredith, Brad Montell, David Osborne, Sannie Overly, Ryan Quarles, Jody Richards, Steve Riggs, Bart Rowland, Jonathan Shell, Kevin Sinnette, Fitz Steele, Wilson Stone, and John Tilley.
Guests: Dr. Shelli Deskins, Director, Highlands Center for Autism, Prestonsburg, Kentucky, Greg Wilson, Tyler Hall, (Parents of children attending Highlands Center for Autism), Lorri Unumb, Autism Speaks, Melody Shrader, Kentucky Association of Health Plans, Kelli Rodman, Humana Insurance, Melissa Metzger, General Counsel, Kathy Lower, Jay Lynn Wagner, Anthem Insurance.
LRC Staff: Rhonda Franklin, Sean Donaldson, and Jamie Griffin.
The minutes from the October 23, 2012, meeting were approved.
Insurance Coverage of Autism Spectrum Disorders Mandated by 2010 RS HB 159
Dr. Shelli Deskins, Director, Highlands Center for Autism, discussed the center’s program. The center treats 10 children, ages 2-15. There are 13 staff members who provide 30-32.5 hours of applied behavioral analysis (ABA). They also provide parent training, home visits, and interaction with parents at the center. Dr. Deskins stated that there has been much success and shared a video on the progress of a child over a 2 year treatment period. The video showed the child who initially was non-verbal but who later spoke her first words and was able to carry out daily tasks. Reimbursement remains a challenge, despite the mandate passed in 2010 House Bill 159. Many times the insurance companies will not reimburse parents, who then must pay the bills themselves.
Representative Steve Riggs stated that there is more work needed to help autistic children.
Representative Jeff Greer stated that he is making a personal pledge to work on streamlining the process between claimants, centers and insurance companies.
Senator Carroll asked about the severity of autism of the girl in the video and whether Dr. Deskins had contacted the Department of Insurance. Dr. Deskins stated that the young girl in the video is severely autistic. Children at the center range from moderate to severely impaired. The center has worked very hard with insurance companies and has filed complaints with the Department of Insurance.
Senator Girdler stated that he has visited the Highlands Center for Autism and encourages members to tour the facility. He applauds the staff’s outstanding work.
Senator Buford asked whether the center accepts Medicaid. Dr. Deskins stated that the center is not a Medicaid provider.
Senator Carroll asked whether the Center has contacted the Department of Education to see if it has access to methods of treating children with autism. Dr. Deskins stated that she had not contacted the department.
Representative Steve Riggs asked how the “Affordable Care Act” affects the center. Dr. Deskins said that remains to be seen.
Greg Wilson and Tyler Hall parents of children who attend the center discussed how ABA treatment at the center has changed and improved their children and families’ lives. They said that the increase in speaking, vocabulary, and learning of daily living skills has been amazing and life changing. The financial struggles have been very hard, but they know they must provide ABA treatment for their children for them to be functioning members of society. They have filed numerous claims for reimbursement with their insurance companies in accordance with House Bill 159 and have received little or no money. Dr. Deskins stated that the struggle with reimbursement is typical of the families at the center.
Lorri Unumb, Vice President of State Government Affairs, Autism Speaks, stated that House Bill 159 has been used as model legislation across the United States. Thirty-three states have laws regarding reimbursement for treatment of autism. She has written a book entitled “Autism and the Law.”
There are several issues hindering ABA treatment:
1) Denial.
ABA is sometimes coded as educational instead healthcare. This is not appropriate because the underlying condition is a medical condition and must be paid.
2) Service not medically necessary.
She stated that ABA treatment is legitimate and is prescribed by a physician.
3) Supervision of treatment.
She stated that there is planning, oversight, and monitoring of the treatment. Many times the treatment is implemented by others.
4) Billing codes.
She stated that billing codes are a problem with insurance companies. The problem is being addressed with the American Medical Association. It would possibly help if the Department of Insurance issued a bulletin regarding the acceptable codes to be used by insurance companies.
5) Providers not willing to be in-network.
She stated that this presents problems for families and providers.
Representative Jim Gooch asked if the Highlands Center was in-network. Dr. Deskins stated that it is not in-network.
Senator Tom Buford asked how the “Affordable Care Act” applies to ABA treatment. Lorri Unumb stated the health care reform prohibits monetary caps, and Kentucky has a $10,000 annual cap for small group members with autism spectrum disorder and $50,000 annual cap for large groups. Senator Buford stated that there may be a need to amend the Kentucky law with legislation to remove caps. Lorri Unumb stated that, in 2010, that 1 in 100 children were diagnosed with autism, and data indicates that 1 in 88 children are diagnosed in 2013.
Melissa Metzger, Kathy Lower and Jay Lynn Wagner, representing Anthem Insurance, Kelli Rodman, representing Humana Insurance, and Melody Schrader, representing United Health Care, discussed insurance reimbursement for autism spectrum disorders.
Ms. Metzger stated that Anthem is committed to working with providers. When House Bill 159 passed, Anthem put together a work group of 100 associates to deal with the changes. Coding is a problem, and the company has contacted families regarding claims that need to be resubmitted to receive reimbursement.
Kelli Rodman stated that Humana has experienced the same issues as Anthem and has worked with members to process claims. Humana is committed to working with interested parties to make the filing and reimbursement process easier.
Representative Greer stated that willingness to cooperate is what he has wanted to hear from all parties.
Senator Buford stated that he feels it is hard to discuss such matters on the phone and that maybe the interested parties should meet, discuss codes for autism disorders, and possibly visit Highlands Center for Autism.
Representative Greer and Senator Buford asked that the parties update the committee on their meetings and any progress.
The meeting was adjourned.