HOUSE BILL REPORT

HB 1365

As Reported by House Committee On:

Health Care & Wellness

Title: An act relating to increasing child health equity by requiring screening for autism and developmental delays for children in medical assistance programs.

Brief Description: Requiring universal screening and provider payment for autism and developmental delays for children in medicaid programs.

Sponsors: Representatives Riccelli, Walsh, Cody, Scott, Jinkins, Robinson, Tharinger, Takko, Senn, Harris, Ormsby, Blake, Kagi, Sawyer, Gregerson, Stanford and Bergquist.

Brief History:

Committee Activity:

Health Care & Wellness: 1/30/15, 2/3/15 [DP].

Majority Report: Do pass. Signed by 14 members: Representatives Cody, Chair; Riccelli, Vice Chair; Harris, Assistant Ranking Minority Member; Caldier, Clibborn, DeBolt, Jinkins, Johnson, Moeller, Robinson, Rodne, Short, Tharinger and Van De Wege.

Minority Report: Do not pass. Signed by 1 member: Representative Schmick, Ranking Minority Member.

Staff: Chris Blake (786-7392).

Background:

The federal Affordable Care Act requires group and individual health plans to provide coverage without a cost-sharing requirement for several types of preventive health services. For infants, children, and adolescents, these services include evidence-informed preventive care and screenings provided for in the Health Resources Services Administration (HRSA) comprehensive guidelines. The HRSA's comprehensive guidelines have adopted the American Academy of Pediatric's "Periodicity Schedule of the Bright Futures Recommendations for Preventive Health Care" (Periodicity Schedule).

The Periodicity Schedule establishes a recommended timetable for patients to receive preventive services from birth to 21 years of age. The Periodicity Schedule lists categories of services and when those services are recommended to be provided. The categories of services include histories, measurements, sensory screenings, developmental and behavioral health assessments, physical examinations, procedures, and oral health services. The developmental and behavioral assessments category includes developmental screenings to be performed at 9 months, 18 months, and 30 months; and autism screenings to be performed at 18 months and 24 months.

Under the Medicaid program, enrollees under 21 years old qualify for benefits under the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT). The EPSDT covers health screening visits according to a schedule related to the enrollee's age. Coverage includes one developmental screening for children between 9 and 30 months old. The EPSDT also covers screening for autism when a child is 36 months of age or younger and is suspected of having autism.

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Summary of Bill:

Medical assistance programs must cover universal screening and provider payments for autism and developmental delays, as recommended by the Bright Futures Guidelines (Guidelines). This will require coverage for developmental delay screenings for children at 9 months, 18 months, and 30 months of age. It will also require autism screening for children at 18 and 24 months of age. The coverage is subject to the availability of funds.

Legislative statements are made regarding the use of the Guidelines in health plans, the results of a Washington State Institute for Public Policy study related to the costs and benefits of using the Guidelines, the health status of children on medical assistance programs, and the ability of primary care providers to provide screenings to children.

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Appropriation: None.

Fiscal Note: Available.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.

Staff Summary of Public Testimony:

(In support) All insurers in Washington currently cover all autism and developmental delay screenings for infants and toddlers as recommended by national standards. Children on Medicaid receive only one-fifth of the autism and developmental delay screenings that children on private insurance get. This bill ensures that all children in Washington receive all of the screenings and get the care they need. This is about equity and giving every kid a fair start.

Bright Futures is a nationally recognized guideline for pediatricians to tell them what they should be doing at each visit.  Since March 2010 all private sector health insurance companies cover all five screenings while children on Medicaid only get one.  The screenings are important for children, their families, and society as a whole. This can speed up referrals for screenings and diagnoses for autism and lead to early interventions. Developmental surveillance only catches 30 percent of delays, while a standardized screening tool identifies about 70 to 80 percent of delays. Testing and diagnosis is the first step to ensuring that children what they need to succeed in school and life.

There are issues with disparities across different racial and ethnic populations. Children of color do not have the same access to diagnosis and responsive services and this is an unnecessary equity gap that impacts a child's future success.

This bill has an upfront cost, but it will save money in the long term.  When caught early, there can be savings to school districts is over $30 million annually.

(Opposed) None.

Persons Testifying: Represenative Riccelli, prime sponsor; Diana Stadden, The Arc of Washington State; Sugely Sanchez, The Arc of Snohomish; LeLach Rave, Washington Chapter of the American Academy of Pediatrics; and Christina Peters, Health Coalition for Children and Youth.

Persons Signed In To Testify But Not Testifying: None.