by Melissa Sortman, MEA Uniserv Director
The MSU self-funded health care coverage will include autism claims for children age 0-19 beginning January 2015. Previously, the coverage was limited to autism claims for children age 0-8. Due to the Mental Health Parity Act and standard of care required under the Affordable Health Care Act, the Joint Health Care Committee (a coalition of Labor and Management) expanded autism coverage.
The APA, in partnership with the Coalition of Labor (CLO) on campus, identified the need for autism coverage for our respective membership. The APA and CLO had been advocating within the Joint Health Care Committee to provide autism coverage. We were successful in achieving the first critical step in autism coverage through bargaining the Wage and Health Memorandum of Understanding 2014-2017.
Michigan mandated under Public Act 101 of 2012 that commercial and non-profit insurance carriers provide autism coverage. Michigan State University is a self-insured provider and does not have to comply with the coverage requirements of insured plans. Any autism coverage had to be bargained in the Wage and Health Memorandum of Understanding.
The autism coverage commenced on January 1, 2014. It covers Autism Diagnosis, Pharmaceuticals, Psychiatric, Psychological, and Therapeutic services (Speech, Occupational, Applied Behavior Analysis, and Physical therapies; and social workers) for children that have been assessed and diagnosed by three Center of Excellence on autism: Spectrum Health System, University of Michigan Health System or Michigan State University.
The Legislature appropriated funds for self-insured employers like MSU by creating an Autism Reimbursement Program. The fund was originally appropriated with $15 million dollars in 2012-2013 fiscal year, an additional $11 million dollars for 2013-2014 fiscal year, and no funds were appropriated to the fund in the 2014-2015 fiscal year. As of September 30, 2014 the balance in the fund was $22 million.
MSU has an expert on autistic medical coverage in Dr. Jane Turner, a professor at the College of Human Medicine, Department of Pediatric and Human Development. Dr. Turner is on Governor Snyder’s Autism Council charged with overseeing Michigan’s Autism Spectrum Disorders (ASD) State Plan. Having a leader in the field on campus assisted MSU’s agreement to expand autism coverage to the self-insured plan. She is a true advocate for children with autism.
If your family has any concerns regarding the autism coverage and related behavioral, speech and occupational coverage, please contact the APA office at (517) 999-4004 or email [email protected]. The APA would like to work with you to ensure the coverage is implemented for the best outcome for your family.
For more information:
1) Senate Fiscal Agency Analysis of PA 101
http://www.legislature.mi.gov/documents/2011-2012/billanalysis/Senate/pdf/2011-SFA-0414-N.pdf
2) Frequently Asked Questions about PA 101
http://www.michigan.gov/documents/lara/LARA_Autism_Fund_FAQ_FINAL_400157_7.pdf
3) Autism Coverage Reimbursement Fund
http://www.michigan.gov/difs/0,5269,7-303-13047_13049-297217–,00.html
4) Autism Coverage Fund Senate Fiscal Analysis 2014
https://www.legislature.mi.gov/documents/2013-2014/billanalysis/Senate/pdf/2013-SFA-5742-L.pdf
5) For additional information and resources, families may want to contact Autism Alliance of Michigan, autismallianceofmichigan.org or Autism Speaks, www.autismspeaks.org.