Over the past several years, efforts to increase autism awareness and provide and expand treatment coverage have been a top priority of Georgia legislators and citizens alike. References to “autism” typically include all autism spectrum disorders, such as autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. According to the American Psychiatric Association, ASD is a “lifelong developmental disability defined by diagnostic criteria that include deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities.”
A recent Centers for Disease Control and Prevention statistic is that 1 in 68 children are diagnosed with ASD, a significant increase since 2000 when the rate was 1 in 150 children. Even more significant is the fact that children in Georgia are diagnosed at a rate higher (1 in 64) than the national average.
HB 429 and SHBP autism health care coverage
Increased public Autism Spectrum Disorders awareness and research studies linking early intervention to better life outcomes for children with ASD have spurred state investment in services and treatment. Both the executive and legislative branches have appropriated additional state funds via legislation to expand ASD treatment options.
After significant work during the 2015 legislative session, House and Senate members passed HB 429, better known as Ava’s Law, requiring private insurance providers in Georgia to include coverage for ASD treatment for children 6 years old and younger. HB 429 includes a $30,000 cap on annual payouts per child and exempts businesses with 10 or fewer employees from the requirement.
Further, insurers are exempt from the requirement if they can prove that ASD treatment coverage will raise all of their premiums by at least one percent. Georgia became the 41st state to require autism coverage and the law went into effect on July 1. Governor Deal was also involved in expanding autism spectrum disorders coverage during the previous legislative session when he proposed $2.4 million for ASD diagnosis and treatment in the State Health Benefit Plan (SHBP) in the FY 2015 budget.
Non-profits funded by recent Legislature appropriations
Despite the gains realized by expanding autism spectrum disorders coverage to private and state health care plans, additional funding is necessary to support uninsured and underinsured portions of Georgia’s population that suffer from ASDs. Research has shown that ASD treatment at an early age can curtail or even negate the effects of ASDs, reducing the overall cost of treatment during an ASD individual’s lifetime.
The past eight budget cycles have seen the Georgia General Assembly continually increase the amount of state general funds appropriated to nonprofit organizations that provide ASD diagnosis, care, and treatment to child and adult patients and their families. Appropriated through the Department of Behavioral Health and Developmental Disabilities’ budget, $4.2 million in state general funds currently flows to the Marcus Autism Center, the Matthew Reardon Center for Autism, the Emory Autism Center, and Community Service Boards each fiscal year to serve various ASD populations in different ways.
The Marcus Autism Center, which serves more than 5,500 autistic children each year, also receives a federal Medicaid match for its portion of the state general fund appropriation and primarily serves Medicaid-eligible children from across the state through evaluations, treatments, therapies, and case management services.
In cases where ASD child patients’ live great distances from the Marcus Autism Center’s home in Atlanta, doctors at Marcus have begun using telemedicine capabilities to expand access and delivery of services across the state. This new health care feature has revolutionized the way Autistic children receive critical care, especially in rural parts of Georgia.
The Matthew Reardon Center in Chatham County receives state funds to support operations of a year-round school for Autistic children in the Savannah area, as well as to develop training programs for parents and teachers. The Emory Autism Center’s appropriation is focused on providing evaluations, treatment, therapy, and training to adults afflicted with ASDs. Such treatment options are important due to the majority of ASD treatment resources being concentrated on children.
Additionally, many of Georgia’s 26 CSBs also have contracts to provide family support services for families affected by Autism. $595,000 is appropriated each fiscal year so that nine CSBs can assist families in meeting the needs of children and adults with ASDs.
Georgia’s executive and legislative branches have recognized the growing needs of families and children affected by this group of disorders and have made positive steps toward ensuring treatment and care is available to greater numbers of Georgians. As the understanding and treatment of children and adults with autism spectrum disorders continues to evolve, the General Assembly will be tasked with an ever more important role in assisting Georgians with being able to receive quality care in pursuit of better life outcomes.
Legislation and final action may be accessed online at www.legis.ga.gov and the state budget can be accessed online at the Senate Budget and Evaluation Web site: www.senate.ga.gov/sbeo/en-US/Home.aspx
I may be reached at
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