Therapy for MO Children
We did it! When we began this journey, a few people told us that while the idea was good, we would never get the autism mandate expanded to cover all disabilities. We accepted the challenge and didn't give up. On May 17, 2019, HB399 passed, but the language was also passed as an amendment on SB514. On July 11, 2019, Governor Parson signed SB514 into law. Missouri is the third state to expand its autism mandate to include all children with disabilities.
This legislation requires insurance to cover medically necessary therapies for children with developmental disabilities. Missouri law already requires this coverage for children with Autism Spectrum Disorders (ASD). Children with ASDs make up half of children with developmental disabilities. This legislation will cover the other 50% of children with disabilities.
On Dec. 1, 2018, Senator Hoskins prefiled SB45. On Dec. 21, 2018, Rep. Basye prefiled HB399. On March 5, 2019, both SB45 and HB399 were perfected in the Senate and House. On May 17, 2019, HB399 made it across the finish line. Our language was amended onto SB514 which was the version actually signed into law. The part with the therapy mandate is section 376.1224.
Our legislation brief is a one-page summary of the bill, as well as its impact on Missouri. We shared this with all the legislators, encouraging them to support this legislation.
This legislation will give children with disabilities full coverage for speech, physical, and occupational therapies. It would also give children with an Autism Spectrum Disorder who have individual insurance plans coverage for therapies under Missouri law.
To get an idea of the cost, below is the current Autism Report put out by DIFP (MO's Department of Insurance). It states that the claims cost increase caused by the autism law was 3/10 of 1%. The impact to premiums was minimal. The cost for habilitative therapies (speech, PT, OT) was only $.39 per member per month (pg 5). Seeing how speech and 20 PT/OT are already covered, the additional claims cost of SB45/HB399 would be significantly less than $.39/mo.
Who will be covered by this legislation?
This legislation only applies to insurance plans which are fully-funded. Self-funded insurance plans do not have to follow state mandates. We have more information about this, as will soon have information available that parents can use to request coverage by employers.
Currently, many insurances do not adequately cover habilitative therapies for individuals with developmental disabilities. These therapies are very expensive, easily running over $100/session, with many individuals needing 3-4 sessions each week. Many individuals with disabilities are not getting the therapies they need to learn and improve basic activities, like walking, talking, and self-care tasks. While some insurances are starting to cover habilitative therapies because of the Affordable Care Act, most cover a limited number, often twenty visits per year. Twenty therapy sessions go fast when a child needs two to three sessions a week.
Long-term Cost Savings
With young children getting the support they need, there will be less children entering into schools requiring special education services. Early intervention reduces the cost to our schools by minimizing the need for special education services.
Therapies give adults the support they need to live independently, including the skills to find and hold a job, maintain a home, and move throughout the community. Many adults with disabilities can be contributing members of our society with a small amount of help.
This legislation will not affect just individual with disabilities. This legislation will make it possible for more private therapy clinics to exist in rural Missouri. Medicaid pays very little for habilitative therapies and it is financially difficult for small town therapy clinics to stay open. Having a guaranteed form of payment would cause therapists and therapy companies to expand their service areas, reaching out into smaller, rural Missouri communities where services are currently lacking. With the increase of private therapy clinics and licensed therapists in small towns, which could be created by this legislation, the schools will be able to hire quality and trained therapists.
Click the box to read individual stories about how Missouri families
would be impacted by this legislation!
In The Media
Click on the following links to read current statewide coverage of our efforts. For past articles, go to MoDE in the Media.