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Florida Autism Mandate

Florida’s Autism Insurance Benefits Mandate Who Will Benefit, Who Will Not, and Why?: Chapter 5

Chapter 5: Developmental Disabilities Compact (Originally published July 7, 2008)

In this and other Chapters, in a Q&A format, we provide some basic information that we hope will help you answer questions you may have on various topics related to the Florida autism legislation.  See Introduction and Table of Contents.

In this Chapter, we discuss in more detail the exemption for signatories of the proposed compact.

Please keep in mind that we are answering general questions that may or may not apply to your specific circumstances.  You should consult a lawyer or other specialist if you think you are entitled to benefits that you do not receive.  Behavioral Lifeboat can help you do that.

Q:  What is the developmental disabilities compact?

A:  The legislation directed the Florida Office of Insurance Regulation (OIR) to establish a workgroup the purpose of which will be to negotiate a compact relating to insurance and access to services for persons with developmental disabilities.  The compact is a binding agreement among the compact workgroup participants that elected to sign the compact.  The legislation also directed OIR to organize a consumer workgroup to provide a forum for comment on any draft of the compact.

Q:  Who was included in the compact workgroup?

A:  The legislation directed OIR to include the following people in the compact workgroup:

  • Two designees of the Governor of the State of Florida, one of whom must be a consumer advocate.
  • A designee of the President of the Florida Senate.
  • A designee of the Speaker of the Florida House of Representatives.
  • Representatives of all providers of health insurance licensed by the State of Florida.
  • Representatives of all health maintenance organizations (HMOs) licensed by the State of Florida.
  • Representatives of employers with self-insured benefit plans (Chapter 6).

The legislation did not designate a limit on the number of members of the compact workgroup who represent the insurance companies, HMOs, or employers with self-insured benefit plans.

The membership list is posted here.

Q:  What does the developmental disabilities compact cover?

A:  The final compact is posted here.  Simply stated, the final compact is the same as the Florida autism insurance benefits mandate.

The legislation provided that the compact would relate to insurance and access to services for persons with developmental disabilities, including autism spectrum disorders.  The legislation mandated certain components of the compact, including:

  • Coverage of developmental disabilities, including autism spectrum disorders.  The insurance mandate only covers autism spectrum disorders.
  • A requirement that each signatory to the agreement provide an unspecified increase in coverage for behavior analysis and behavior assistant services, speech therapy, physical therapy, and occupational therapy when medically necessary due to the presence of a developmental disability.
  • Procedures for clear and specific notice to policyholders identifying the amount, scope, and conditions under which such coverage is provided.
  • Penalties for documented cases of denial of claims for medically necessary services due to the presence of a developmental disability.
  • Proposals for product lines that may be offered with traditional health insurance and provide a more appropriate means of spreading risk, financing costs, and accessing favorable prices.

The legislation did not require that the compact include any specific benefits or that the benefits required by the compact include any or all of the benefits required by the autism insurance mandate.  Specifically, the legislation did not require that the compact signatories comply with the aggregate dollar limits per child of the mandate ($36,000 annually and $200,000 lifetime) or any other parity requirements.  See Chapter 3 to compare the mandate’s coverage requirements.

The legislation did not establish any procedures for approving the compact.  The legislation did not specifically require that the designees of the Governor, House and Senate must unanimously approve the compact before it is signed.  OIR did not issue regulations to clarify these procedures.

Q:  Who signed the developmental disabilities compact? 

A:  Signing the compact was optional.  The legislation did not provide that any member of the compact workgroup was required to sign the compact.  Total Health Choice, Inc. was the only signatory.

As we explain in detail in Chapter 6, self-insured health plans are generally exempt from Florida’s autism insurance mandate.  Federal law (ERISA) prevents states from regulating benefits offered by employer sponsored benefit plans, including health benefits.  As a result, the State of Florida could not mandate that members of the compact workgroup representing employers with self-insured benefit plans must sign the compact.

Only insurance companies and HMOs had an incentive to sign the compact.  ERISA preemption does not apply to health benefits provided by insurance companies and HMOs.  As a result, they generally oppose state insurance mandates.  Any insurance company or HMO that signed the compact by April 1, 2009, would have been exempt from the autism insurance mandate and will have had until April 1, 2010 to comply with the terms of the compact.

Q:  After the developmental disabilities compact was signed, what happened next?

A:  After the compact negotiations were complete, OIR reported the results of the negotiations to the Governor, the President of the Senate, and the Speaker of the House.

In all cases, insurance and HMO contracts sold by any insurance company or HMO that signed the compact no later than April 1, 2009 were exempt from the autism insurance mandate and had until April 1, 2010 to comply with the terms of the compact.  OIR reported to Governor Crist that, as of February 15, 2010, the sole signatory of the Compact concluded that no claims had been filed by individuals diagnosed with a developmental disability at 8 years of age or younger.

Q:  Does any other state autism insurance mandate include such an exemption? 

A:  [This section has not been updated since 2008 – see “Q&A: Autism Speaks State Autism Insurance Reform Initiatives.”]  Several states (for example, Arizona, Indiana, Pennsylvania, South Carolina and Texas) have enacted legislation that includes mandates that are similar to the Florida mandate.  Yet, none of these states included a comparable compact in their legislation.  Please read Chapter 9 to understand how the compact was first proposed and Chapter 10 to learn what else we can accomplish.

If you have questions, please comment in the Behavioral Lifeboat blog.

© 2008, 2011 Richard W. Probert

About Behavioral Lifeboat

Behavioral Lifeboat is a nonprofit organization. Our mission is to make evidenced-based behavioral therapy accessible to all by increasing awareness, helping to make comprehensive insurance benefits affordable and meaningful, helping schools provide more effective behavioral therapy programs, and providing grants to make such therapy affordable when other solutions are not available.

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