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Lawmakers look to have insurance plans cover therapies for kids with disabilities

JEFFERSON CITY, Mo. — Robyn Schelp’s 11-year-old son is an example of just how important and beneficial therapy is for those with developmental disabilities.

Nathan has an unknown genetic disorder, and the family relocated from rural Missouri to Columbia in order to access the therapies he needs at a discounted rate or enroll in programs that will pay for them.

It is that therapy that enabled Nathan the to testify before a House committee on Tuesday for the first time.

“The therapies for these kids are like medicine for someone else. This is what helps them, and they couldn’t get it,” Schelp told the Missouri Times.

She noted the therapies are expensive for families and mostly not covered by insurance. With Nathan in tow, Schelp has been walking the halls of the Capitol for several years working to provide relief to families.

That work just may pay off this year with identical bills in each chamber making their way through the Missouri General Assembly.

On Tuesday, the House Health and Mental Health Policy Committee held a public hearing on Sen. Denny Hoskins’ SB 45. On April 10, the Senate Health and Pensions Committee passed Rep. Chuck Basye’s HB 399.

The bills look to complete an issue that was partially addressed in 2010 when lawmakers voted to require insurance policies to cover therapies for children with autism. Both bills would expand the existing autism mandate to cover other developmental disabilities.  

“It’s important because under current Missouri statute, insurance carriers must provide insurance for those children on the autism spectrum, however, many other children with other developmental disabilities are not covered under insurance. This bill would ensure those kids receive the therapy they need so they can grow up and be independent, happy adults,” Hoskins said.

“This will give those kids with genetic disorders, down syndrome, cystic fibrosis, and other developmental disabilities…access to a lot more therapies,” Basye said. “It’s proven that the sooner these kids get into a therapy program the better chance they have of being more independent in life, or completely independent.”

The bill adds therapeutic care for developmental and physical disabilities, as such terms are defined in the act, to the insurance coverage mandate for autism spectrum disorders effective January 1, 2020.

Providers would have the ability to limit the number of therapeutic care visits per year for the expanded disabilities. The therapies would only be covered if approved and deemed medically necessary by the health benefit plan.

As part of a compromise, the legislation would repeal the requirement that the Department of Insurance, Financial Institutions, and Professional Registration submit annual reports to the legislature and require health carriers to supply certain diagnosis and coverage information for the report.

Expanding coverage to include physical and developmental disabilities is projected to increase the cost of insurance plans between $0.39 to $0.51 per member per month. The $0.51 projection is based on the 2018 cost to cover therapies for children with autism. Since the expanded legislation wouldn’t cover all of the same therapies, $0.39 reflects the cost of what would be covered, according to Schelp.

“It’s not a lot if those kids get the kind of help they need,” said Hoskins.

“It is something that needs to be done,” Hoskins added. “As you can see by Nathan’s testimony, the therapy is working. When we get these kids into the type of therapy they need, they are going to grow up and have a lot better chance of being self-sufficient.”