July 29--While the new autism insurance law took effect in June, many employees and their families still aren't covered -- including those at WVU Hospitals (WVUH).

"Since WVU Healthcare's WVU Hospitals is a private employer, our health insurance plan is selfinsured and we are exempt from the autism legislation," said Charlotte Bennett, vice president of Human Resources for WVU Healthcare.

This means that nurses and other hospital staff aren't covered. But doctors are -- they work for WVU, a public university, and are insured by the state Public Employees Insurance Agency.

State autism insurance legislation first passed in 2011, and was revised to clarify some confusion in 2012.

"Even though we are exempt," Bennett said, in an email, "we have been reviewing and evaluating this type of coverage since the legislation was announced. We will continue our evaluation as more information becomes available and determine our approach on how to move forward based on the needs of our employees and the organization."

The delay in WVU Healthcare's decision doesn't sit well with some employees who have children with autism.

"I was not very pleased when I heard that it wouldn't be covered in 2012," said one nurse who has twins with autism.

The nurse is concerned because her twins are 4 1/2, and said early intervention is crucial to improving symptoms of autism.

"With a tight window of time, I'm very discouraged that people are not taking care of this in a timely fashion," she said. "WVU Healthcare really tries hard to take care of its nursing staff. ... In this case, it's hard to swallow.

According to medical papers available from Autism Speaks, the national nonprofit autism advocacy group: "There is no debate or doubt: Early intervention is your child's best hope for the future. Early attention to improving the core behavioral symptoms of autism will give your child -- and the rest of the family -- several important benefits that you will not gain if you take a wait-and-see approach until your child enters school at age 4 or 5."

Some background

According to the Self Insurance Institute of America: "A self-insured group health plan is one in which the employer assumes the financial risk for providing health care benefits to its employees. ... Typically, a self-insured employer will set up a special trust fund to earmark money (corporate and employee contributions) to pay incurred claims." Plans vary, but many employers use a third-party administrator to handle claims and other matters.

According to the state Department of Health and Human Resources (DHHR) Self Insurance Division, 90 West Virginia-based companies are self-insured. The division didn't have at hand how many people -- employees and their families -- that includes.

The Self Insurance Institute said that according to a 2000 report by the Employee Benefit Research Institute, about 50 million workers and their dependents nationwide receive benefits through self-insured group health plans -- about 33 percent of the 150 million total participants in private employment-based plans nationwide.

The state's autism insurance legislation -- Gov. Earl Ray Tomblin came to Morgantown to sign the bill at WVU'sCenter for Excellence in Disabilities --applies to PEIA, WVCHIP, and private insurers, but not self-insured companies. The legislation mandates insurance coverage of applied behavior analysis (ABA) -- the accepted form of intensive treatment for autism spectrum disorder -- with a $30,000 per year cap for the first three years after diagnosis and $2,000 per month thereafter until age 18.

The legislation also doesn't apply to Medicaid, but DHHR said ABA is covered by Medicaid as an accepted technique of professional counseling, with no age limit, when medically necessary. Information from WVU's autism clinic seems to contradict this -- the clinic reported children under Medicaid are not covered for services.

WVU, Marshall and autism treatment

WVU Healthcare spokeswoman Amy Johns said 4,427 employees are covered by WVUH health insurance.

When asked how many might have children who could require autism treatment, she said they don't track the number of employees who have children.

WVU -- not WVU Healthcare -- provides services for children with autism at its Center for Excellence in Disabilities (CED) intensive Autism Service Delivery Clinic.

The clinic has limited resources and funding and treats, free of charge, six children -- one full time, five part time. There is a waiting list -- at one time there were about 30 children on it -- said Dr. Susannah Poe, who directs the clinic. She is a psychologist, medical school professor and Board Certified Behavior Analyst -- qualified to administer ABA.

Barbara Becker-Cottrill is executive director of Marshall University'sWest Virginia Autism Training Center, which has a branch in Fairmont. The center has no certified behavior analysts on staff right now, and doesn't offer ABA as such.

"Our main intervention model is based on positive behavior support which uses the principles of applied behavior analysis," she said. "ABA strategies are entwined in all" of its programs.

Becker-Cottrill and Marshall benefits coordinator Lisa Henry said all Marshall University employees are covered by PEIA, and covered by the autism legislation. There is no private, selfinsured entity that shares the Marshall name.

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(c)2012 The Dominion Post (Morgantown, W.Va.)

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