|
May 2009
TDI Legislative Action (Email from TxABA)
The Texas Department of Insurance (TDI) has requested comments on their final draft of the implementation guidelines for the legislation mandating insurance coverage for applied behavior analysis services for individuals with ASD and their families. The legislative committee of TxABA has reviewed the draft guidelines and recommends commenting on two issues in particular. Please remember that TDI is not in a position to change any of the legislation but is only attempting to clarify how the legislation should be implemented.
The following letter (attached below) is intended to serve as a template that you may use to communicate with TDI re: the implementation guidelines. Please note that: (1) identical copies of your letters must be sent to two individuals: Gene C. Jarmon, General Counsel and Chief Clerk and Debra Diaz-Lara, Deputy Chief, HWCN Division; and (2) the letters must be mailed (as opposed to sent electronically) and must be received by Monday, May 4, 2009.
The addresses for the two individuals are:
Gene C. Jarmon
General Counsel and Chief Clerk
Mail Code 113-2A
Texas Department of Insurance
P.O. Box `149104
Austin, TX, 78714-9104
And
Debra Diaz-Lara
Deputy Commissioner, HWCN Division
Mail Code 103-6A
Texas Department of Insurance
P.O. Box 149104
Austin, TX, 78714-9104
Sincerely,
The TxABA Team
________
Template of letter to be sent to TDI
Gene C. Jarmon
General Counsel and Chief Clerk
Mail Code 113-2A
Texas Department of Insurance
P.O. Box `149104
Austin, TX, 78714-9104
Subject: Input on draft rules- Title 28; Insurance; Part 1; Subchapter JJ, 21.4401-21.4404
Mr. Jarmon:
I am writing to provide input on the recent draft rules pertaining to insurance coverage for children with autism spectrum disorders (ASD), specifically regarding Title 28; Insurance; Part 1; Subchapter JJ, 21.4401-21.4404.
Indicate whether you are a parent or a professional and insert some personal information describing the relevance of the referenced bills.
Many families struggle greatly to obtain needed services, especially scientifically-validated ones such as ABA, to help their children achieve as much independence as possible, experience the greatest possible quality of life, avoid institutionalization, and reduce the lifetime costs of special services. Until now, insurance coverage of those services has been exceedingly limited and seemingly arbitrary. The TDI draft rules when implemented will provide important help to many families in achieving these important outcomes with the assistance of insurance coverage. Coverage by insurance of at least a portion of the costs of ABA services which need the oversight of a person with demonstrated expertise in the field of applied behavior analysis, shown by possession of certification by the Behavior Analysis Certification Board (BACB), a fully recognized international credentialing body, will be very helpful for those families and their young children as well as for the public at large (e.g., due to reduced costs for expensive special services).
I believe that addressing the following items will result in the most effective implementation of the legislation designed to provide insurance coverage for the important services required by children diagnosed ASD and their families:
1. 21.4402.(5)- Definition of �Health care professional�- To minimize confusion and delay in decisions regarding whose applied behavior analysis services will be eligible for insurance coverage, I recommend explicit mention here of Board Certified Behavior Analysts as they are eligible providers by virtue of the fact that they are eligible to provide these services under TRICARE which makes them eligible under this rule according to section 21.4404 (a) (3).
2. 21.4404. (b)- Coverage for Applied Behavior Analysis. The language regarding what health care providers are considered eligible should explicitly state that an insurer shall provide coverage for services for autism spectrum disorder by a provider with the Board Certified Behavior Analyst credential issued by the BACB.
*** Add any other items that you feel are important and not addressed in this template letter. ***
I believe that incorporation of these recommendations will result in the implementation of HB 1919 being more efficient and effective, with increased benefit to the citizens of Texas, most especially young children with ASD and their families.
Thanks for your time and consideration.
Sincerely,
________________________
Copy:
Debra Diaz-Lara
Deputy Commissioner, HWCN Division
Mail Code 103-6A
Texas Department of Insurance
P.O. Box 149104
Austin, TX, 78714-9104
|
