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Legislative Roundup: Midwives, Autism Treatment Coverage

By Rose Hoban

With a legislative deadline to pass bills from one house of the General Assembly to the other that passed Thursday night at midnight, more than 150 bills dashed through committee meetings and floor votes this week.

Some made it to the floors of the House and the Senate to be voted on and thus stay alive, and some were left on the side of the road.

Measure to update licensure for nurse-midwives dies in House

After a tight vote in the House Health and Human Services Committee, a bill that would have given nurse-midwives more latitude in their practice was passed last week.

But the bill was downgraded to one that would only study the proposal over the coming legislative interim.

At least a half-dozen midwives attended the House Judiciary C Committee meeting Wednesday morning to support the bill, which was amended to create the study.

“Studies have been done before; it’s probably a longer process for it to be killed again, but at least it buys us some time,” said nurse-midwife Maureen Darcy, director of the Women’s Birth and Wellness Center in Chapel Hill. Darcy used to be part of the Joint Midwifery board for the boards of Nursing and Medicine.

But the bill was more short-lived than Darcy expected.

During House floor debate Wednesday evening, House rules chairman Tim Moore (R-Kings Mountain) re-referred it to his committee. This effectively killed the bill, meaning it would not meet the crossover deadline.

“There’s some discussions going on right now between, as far as I know, the nurse-midwives and the medical society,” said Moore, who maintained the bill could pop back up in a larger omnibus study bill filed at the end of the session.

He said he was unsure who asked to have the bill pulled, but that he’d received the request in a note.

When reminded that other study bills had already been passed on Wednesday, Moore responded that this was a mistake. “We’ve frankly put too many study bills on the calendar and moved them out,” he said. “There’s not always a method to the madness.”

Chip Baggett, legislative relations head of the Medical Society, was present outside the House chamber with other representatives from the organization. He declined to comment on the bill.

“I think the Medical Society was surprised that it passed that first vote in the health committee, and then it was all-out war after that,” said Darcy.

North Carolina Health News requested a comment from a Medical Society spokeswoman, but no comment was forthcoming.

Autism treatment bill heads to Senate

A bill that would cover intensive treatment for kids with autism made it over the crossover deadline late Wednesday after passing in the House of Representatives overwhelmingly.

The bill would mandate that insurance companies operating in North Carolina cover a treatment for autism called applied behavioral analysis (ABA), a technique based on intensive one-on-one interaction with a specially trained therapist.

Currently, many insurance plans cover autism-diagnosis services and medical-based treatments such as prescription drugs and physical, occupational and speech therapies.

ABA therapy can cost tens of thousands of dollars per year – up to $75,000 in some few cases – mostly paid by families out of pocket. But advocates for the treatment argue that the costs are worth it for the improvements seen from the therapy.

Lorri Unumb, vice president for governmental affairs for national advocacy organization Autism Speaks, had an experience with her own son, whose communication was severely impaired due to autism.

“Our lives and his life are dramatically different after treatment,” Unumb said. “He’s still limited in verbal ability; he’s not conversational, but he can say some words. Recently, he learned to say ‘hamburger’ or ‘pizza’ or ‘corn dog’ or ‘spaghetti.’ He has opinions!”

Unumb points to research done at UCLA that shows that almost half of autistic children receiving the therapy are eventually able to be mainstreamed in school and another 40 percent are placed in less intensive special-education environments, while only 11 percent end up in self-contained classrooms. In a comparison group that didn’t receive ABA, more than 90 percent ended up in self-contained special-education classrooms.

Some insurers, including BlueCross BlueShield of North Carolina, argue that the therapy is more educational than medical and as such should not be covered by insurance.

“We are concerned that the addition of this mandate will be costly and will have an impact on premiums,” said BCBSNC spokesman Lew Borman.

Lobbyists from other insurers, small-business organizations and, in the end, the State Health Plan worked to defeat the bill.

“Certainly the opposition was working the halls very hard,” said Jennifer Mahan, director of government relations for the Autism Society of North Carolina. “We spent time going back to people and talking with them to make sure they understood it was important, that the cost was incredibly low and that they could do this.”

Unumb said the cost of covering the treatment for health plans in other states has averaged about 30 cents per member per month.

In the end, the argument to support autistic children was overwhelmingly supported, even by people who are usually opposed to insurance mandates.

Some of those premium concerns were allayed by an option allowing small businesses to drop the coverage if the costs grow too quickly and by placing an annual cap of $36,000 on the coverage.

The bill passed with a final vote of 105-7 and moves now to the Senate.

“When you see 105 votes on the leaderboard, that sends a great message to the people of North Carolina that we do care,” said Tom Murry (R-Morrisville), who co-sponsored the bill.

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