N.C. legislators pushing for insurers to cover more costs of autism treatment

A behaviorial treatment for students on the autism spectrum has been praised for its effectiveness — but it’s not required to be covered by health insurance in North Carolina.

Applied behavioral analysis is a form of therapy that helps people with autism reduce problematic behaviors and acquire skills such as language learning through the use of reinforcement.

Legislators, educators and health officials hope to soon see a mandate that the treatment be covered by insurers.

Applied behavioral analysis has a broad definition and is used in settings outside of psychological treatment, said Victoria Shea, a professor of psychology at UNC who works with TEACCH, a UNC-based service organization that works with people with autism.

“It’s a way of applying learning principles and seeing the effect of that application,” she said.

And it’s effective, said Kristin Yonkers, clinical supervisor at the Mariposa School for Children with Autism in Cary.

“It’s really the only approach that shows success time and time again,” she said.

A recent by the Centers for Disease Control and Prevention found that 1 in 68 U.S. children are on the autism spectrum.

Last summer, the N.C. House of Representatives passed a bill to mandate the inclusion of the treatment in insurance coverage.

The bill aims to cover screening, diagnosis and treatment for people on the autism spectrum ages and younger.

Rep. Phil Shepard, R-Onslow, who is sponsoring the bill, said he hopes to see it picked up in the upcoming short session.

“If there’s areas we need to work on to make it better, I am willing to make it work in that direction,” he said.

Thirty-one states already require insurers to cover autism treatment.

While North Carolina mandates coverage of costs associated with autism as a part of the larger category of mental health, it does not have an autism-specific requirement.

Blue Cross Blue Shield of North Carolina, which provides UNC student health plans, covers autism treatment for medical services and related interventions, but not applied behavioral analysis.

“BCBSNC doesn’t cover interventions that are experimental, investigational or educational in nature for any diagnosis,” said Lew Borman, spokesman for the company, in an email.

He said the company is concerned covering education programs, behavior management and other therapies would increase costs.

Shepard said research shows insurance rates would rise slightly if the proposed mandate was instituted, but he thought they would not be as high as rates associated with mandates from the Affordable Care Act.

Shea said the bill could expand behavioral support and psychological services that students might use.

“The focus of this bill is not specifically on college students on the spectrum, but it could potentially benefit them,” she said.

Neither UNC’s Accessibility Resources nor Counseling and Psychological Services offers the treatment for students. Avery Cook, a clinical coordinator at Campus Health Services, said they’d likely refer a student to treatment off-campus because it would be a long-term process.

Yonkers said it is hard for her to be completely optimistic about the future of autism treatments in the state.

“North Carolina’s really falling behind the rest of the country when everyone else is moving ahead,” she said.

state@dailytarheel.com