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TOWN AND COUNTRY, Mo.
Tracy Fritz recalled the shock of learning her 3-year-old daughter, Louisa, had autism. Even worse, when the family found a therapy that had potential, insurance wouldn't cover it.
For some Missourians, that is about to change. Gov. Jay Nixon on Thursday signed a bill making Missouri the 21st state to require insurance coverage for some children with autism-related disorders. The ceremony was at St. John's Mercy Medical Center in suburban St. Louis, one of several hospitals that pushed for the measure.
The law, effective Jan. 1, seeks to help families that have maxed-out credit cards, refinanced homes and exhausted their savings to pay for intensive therapy for autistic children. Under the measure, group insurance policies regulated by the state must cover up to $40,000 a year for diagnosis and behavioral therapy for autistic children through age 18.
The bill specifically requires coverage of a therapy called Applied Behavioral Analysis, or ABA. Nixon said experts believe ABA is a vital tool in helping children with autism and related disorders.
Fritz and her husband, Barney, are both physicians, so they could afford the ABA therapy doctors at St. John's recommended for Louisa. A year after the diagnosis, Fritz said the change in the little girl, now 4, has been remarkable.
"When we began she couldn't say mommy or daddy," Fritz said. "She was unable to communicate even her most basic needs."
Now, Louisa speaks and interacts with her preschool playmates and siblings -- she happily chased her big sister around the hospital atrium after the ceremony.
"Now, the words mommy and daddy are music to our ears," Fritz said. "Now, instead of Barney and I being fearful of her future, we're hopeful."
Autism is a broad term used to describe a spectrum of neurological disorders in which children often struggle with communication, behavior and social skills. The federal Centers for Disease Control and Prevention says autism affects about 1 out of every 110 children in the U.S.
Nixon said the bill makes Missouri a national leader in the diagnosis and treatment of autism. For example, unlike other states, Missouri's bill has a cost-of-living escalator. The $40,000 cap could rise every three years, based on inflation.
"With the bill I'm signing today, parents of children with autism -- who have faithfully paid their insurance premiums -- will finally get the coverage they are entitled to," Nixon said.
The mandate would cover about one-fourth of Missouri's population -- mainly those receiving health insurance from small- to medium-sized employers. Large employers who insure themselves are federally regulated. And people with individual insurance policies would have an option -- not a requirement -- to buy autism coverage.
Businesses with 50 or fewer employees could get an exemption from the autism insurance mandate if they can show it caused their premiums to rise by at least 2.5 percent over the previous year.
An actuarial analysis last year by the consulting firm Oliver Wyman -- conducted for the advocacy group Autism Speaks -- estimated that an autism insurance requirement would result in a less than 1 percent increase in the cost of premiums in Missouri. But some in the insurance industry said the increase could be closer to 3 percent.
"No one knows, but it will have a cost to the employers buying coverage for their employees," said Brent Butler, government affairs director for the Missouri Insurance Coalition.
Butler said the measure that passed the Legislature was a compromise.
"It does have some protections that the costs will be kept in check, and it does require that the folks providing the services to these children are credentialed," Butler said. "We wanted to make sure the people were qualified and appropriate."
The bill's sponsors include two lawmakers with autistic relatives. Sen. Eric Schmitt, R-Glendale, has an autistic son, Stephen. The 6-year-old autistic grandson of Rep. Dwight Scharnhorst, R-Manchester, died of epilepsy in 2007.
"Stephen and the thousands of children like Stephen have led us to this place," Schmitt said at the bill-signing.