Autism insurance help faces delay in Va.

Hundreds of families across Virginia who had counted on mandated insurance coverage for their autistic children next month may have to wait untold months more for help.

Despite a law signed by Gov. Bob McDonnell in May after more than a decade of lobbying that requires the insurance and that becomes effective in January, implementation of the law is being delayed by the state Department of Health Professions because of what some observers describe as a questionable need for a "technical fix" in the law.

Longtime advocate John W. Maloney of Richmond accuses state agencies and others of "deliberately dragging their collective feet" to appease business interests "while 3-year-olds with autism don't get treatment."

"It's unconscionable and breaks a promise from the governor that hundreds of families would have this valuable care available to them," said Mark Llobell of Norfolk, a founder of the Virginia Autism Project and the grandfather of an autistic boy. He has spent tens of thousands of dollars from retirement benefits and second mortgages to pay for special care for his grandson that would be covered by insurance under the new law.

But the governor's office is pointing to Attorney General Ken Cuccinelli, whose office concluded that the new insurance law cannot mandate the state Board of Medicine to create a licensing regimen for a special class of therapists trained in handling autistic children.

"It was the governor's intent for the Board of Medicine to promulgate the necessary regulations consistent with the law," said McDonnell spokesman Tucker Martin. "However, upon advice from the Office of the Attorney General, the board declined to promulgate the regulations until additional legislation was passed."

The attorney general's objections are not clear. A spokesman referred a reporter to the state Department of Health Professions, which oversees the medical board. Minutes of a meeting in October show that assistant attorneys general went into closed session with board members and emerged with a decision to seek new legislation "to authorize the licensing of applied behavior analysts."

No one in the autism community seems to understand what form of new legislation would address the attorney general's objections, Llobell said.

The existing law places a cap on annual coverage and limits care to children from 2 to 6 years old; state employees would be eligible but companies of fewer than 50 employees would not have to provide the coverage.

Autism spectrum disorders affect one in 94 boys and about 1 in 150 girls, studies show. Families say autism therapy can cost as much as $30,000 a year.

Applied behavior analysis is a therapeutic practice that is elemental to autism care; it involves intense one-on-one training and is taught across the country and certified through a nationally recognized organization, the Behavior Analyst Certification Board. McDonnell gained an amendment to the original autism bill asking for the licensing provision, apparently to better control who is authorized to provide reimbursable care.

Teresa Champion, with Virginia Advocacy, said Virginia families are exhausted by the decade-long fight for insurance and the constant nuanced setbacks they encounter. Meetings scheduled this fall across the state to familiarize families with the new law are morphing into gripe sessions of disappointment, she said.

A session is scheduled today at 10 a.m. at River Road United Methodist Church at 8800 River Road in Henrico County.

Champion, Mahoney and others do not understand why the state cannot simply endorse the BACB certifications.

"Requiring health plans to accept the (certification board) credentials in lieu of licensure would provide Virginia a very straightforward, cost-effective way to implement its autism insurance law without unnecessary delays," said Gina Green, executive director of the Association of Professional Behavior Analysts in California.

Green said "the overwhelming majority" of the 29 states that have adopted autism insurance laws accept the national (certification board) credentials … without licensure or other additional state regulation."

Champion, meanwhile, is incensed. She says insurers already are absorbing premiums to cover the insured therapies, and families, meanwhile, are looking at yet another legislative session and exposure to the passed bill that could load it up with new provisions and restrictions.

"The sad part is that it means a whole new generation of children are apparently going to lose the coverage that they were promised months ago and that we've fought for for more than a decade," said Llobell, the Norfolk grandfather who was one of the originators of the insurance effort.