- Associated Press - Thursday, March 12, 2015

PIERRE, S.D. (AP) - A bill that would mandate that certain insurance plans cover a costly but effective treatment for children with autism and would lay the groundwork for further coverage in the future is headed to the governor’s desk for his signature.

A group of lawmakers from both chambers ironed out a compromise Thursday that would require certain insurance plans to cover applied behavioral analysis therapy, which is not currently required of insurers in South Dakota but is in 38 other states.

Both the Senate and House passed the compromise version of the bill Thursday, sending it to Gov. Dennis Daugaard, whose administration supports it.

The bill requires coverage of ABA therapy only by providers who have a master’s or doctoral degree, which parents of autistic children say lessens its impact by limiting their options. But the legislation also establishes a workgroup of parents, lawmakers and insurers who will begin meeting this summer to figure out how to expand required coverage in the future.

“We’re grateful that it’s at least being recognized as something that needs to be covered, but there’s no question we need to expand coverage from this point,” said Lisa Stanley, a parent with an autistic child who has testified on the bill. “I think our hope is with the legislation on the books that we’re going to be able to expand from there.”

Parents say the majority of the hands-on ABA therapy provided to children is from specialists who have high school degrees or higher, but not often master’s or doctoral degrees. They say limiting coverage doesn’t cover the majority of care given to children on a day-to-day basis. But insurers, who supported the version of the bill passed Thursday, had been worried about being required to provide coverage for workers who are not licensed to give care by the state.

The workgroup aims to establish a proposal for licensing and covering care providers not included in the bill passed Thursday.

Lobbyists for insurance companies applauded the compromise.

“One of our biggest concerns was that we need supervisory capacity within our state, we need standards established within the state of South Dakota for people providing this care,” said Darla Pollman Rogers, who represents Wellmark Blue Cross Blue Shield and America’s Health Insurance Plans. “We were able to able to work that into this bill and also take care of a few other concerns.”

The bill also mandates that insurance companies have to pay at least $36,000 in ABA costs every year, although they aren’t limited from covering more.

Senate Majority Leader Tim Rave, who had concerns over requiring insurance companies to cover some providers, said he was pleased the committee was able to strike a compromise. Majority Leader Brian Gosch said he was also happy but would’ve liked the bill to go farther.

Kim Malsam-Rysdon, the South Dakota Secretary of Health, said Daugaard’s administration supported the amended version of the bill and looked forward to being involved with the workgroup.

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