Autism Insurance Reform SB5203/HB1210 (Shayan’s Law)

Washington has Full Mental Health Parity and laws requiring home healthcare to protect the
insured from institutionalization. Yet individuals with autism are falling through the cracks.
Evidence based treatment based on national standards are denied by all WA insurance
carriers & deemed “educational, experimental and habilitative”, subsequently a highly
treatable medical condition is becoming a lifelong debilitating disorder that forces children into
fully staffed facilities and residential habilitative centers at up to $240,000 per year, per 1
child.
What is covered under Shayan’s Law
Insurance Carriers: fully funded private health insurers & public employees plans
Diagnosis of Autism Spectrum Disorders by a licensed physician or psychologist.
Treatment for ASD
o Determined medically necessary by a licensed physician or psychologist
o Habilitative and Rehabilitative therapies
o Psychiatric and Psychological care (including Applied Behavior Analysis)
o Pharmacy care: medications for co-occurring medical issues such as major
digestion-system difficulties and seizure disorders, ADHD and anxiety).
Limits of Coverage: Same as WA mental health parity.
Cost savings & new jobs created for every one child with autism
DSHS/DDD annual expenditure on Autism: 60 million dollars, $54,174,532 on direct
medical expenses. GAO report indicates 18% have private insurance. When private
insurance becomes primary payer, the state would save $11,308,389 per biennium including
benefits paid for state employees. New jobs created by Autism Insurance Reform: For
every one child who gets autism benefits there will be 1 new behavior therapist position that is
created, potentially 2400 new jobs.
Companies with Autism Insurance Benefits
Self Insured employers in WA State, including Microsoft, Home Depot, AOL and Boing
as well as Active Military offer Autism benefits & coverage of evidence based treatments.
Data on Best Practices
Washington Institute of Public Policy's published report, Oct. 2009-Intensive behavioral
intervention based Applied Behavior Analysis.
National Autism Center "National Standards Project" Sept. 2009, “11 “Established”
Treatments: The overwhelming majority of these interventions were developed in the
behavioral literature (Applied Behavior Analysis, behavioral psychology, and positive behavior
support)."
Applied Behavior Analysis (ABA) The Surgeon General, American Academy of Pediatrics,
National Institute of Child Health and Human Development, National Research Council, and
other prominent groups list ABA-based interventions among the most recommended
treatment for ASD.
Contact: Arzu Forough Arzu@WashingtonAutismAdvocacy.org
Visit our website: www.WashingtonAutismAdvocacy.org