Act 62 – What Will It Really Mean for Pennsylvania?

Before I get into my post for today, I promised that I would announce the topic suggestion for next week's Try This Tuesday ahead of time. Of course, you can still post about anything you want, but if you are so inclined, this week's topic will be Pets. How do you decide whether getting a pet would be good for your family, including your child with special needs? Are there any special things you considered in choosing a pet, or in deciding not to get one? How did you teach your child to interact properly with it? Any regrets about your decision, whether it was to get one or to not get one?

(As you might imagine, I have an ulterior motive in suggesting this topic, as the question of getting a pet is brought up regularly in our household. So if you have any tips, please share them on Tuesday and link up to the Try This Tuesday post.)

Okay, now onto my post for today:

Last night, Michael and I attended the monthly support meeting of our local chapter of the ASA (Autism Society of America). Michael loves going because he gets to play with some of the other kids, and this time he even made a new friend. I enjoy it for a little adult time with other moms and dads who are also dealing with the disability in their lives.

They try to have a guest speaker each month, and this month we heard from David Gates of the PA Health Law Project, an organization that "provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services." The topic under discussion was the recently passed insurance bill, Act 62 (HB1150), which goes into effect as of July 1, 2009.

Although this bill is a huge step forward for children with autism who are being denied treatment and services through their private insurance, there are still many unanswered questions and concerns about how it will be implemented.

For instance, one of the requirements is that you have health insurance provided through your employer and issued in Pennsylvania. But what if you live and work in PA while your company is actually in another state – where is the policy considered to be issued? Unfortunately, the Dept of Insurance has not been able to answer that question yet.

And if you work for a small company, are self-insured, or work for a large company that has self-funded insurance, the act doesn't apply to your policy anyway. Of course, those plans may eventually add some coverage, but it is not required by law. As far as I can tell at this point, our plan will not be covered, so we will likely continue as is accessing Medical Assistance, but that could change if the state decides it isn't saving enough money and either closes our loophole or starts charging a premium for it.

There are some major issues surrounding the question of providers from the Medical Assistance realm joining up with private insurers, and vice versa. The coverage for autism services has a cap of $36,000 per year, and no one wants to have to switch providers when the money runs out each year. And what if the services you have been getting through MA are suddenly determined "not medically necessary" by the private insurance company?

I won't go on because it would take pages to cover the issues I am aware of, and that is only a fraction of what has to be figured out in the next few months. The main thing is that we find a way for these two systems to work together to fulfill the intent of the law that was passed to give children with autism access to treatment and services designed for autism rather than for mental illness, which is what we have now.

My head is swimming just thinking about it.

Trish can be found writing here at 5MFSN every Friday in addition to hosting Try This Tuesday. You can also find Trish blogging at Another Piece of the Puzzle and Autism Interrupted.