Washington State House of Representatives Office of Program Research | BILL ANALYSIS |
Health Care & Wellness Committee |
SSB 5317
This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent. |
Brief Description: Requiring universal screening and provider payment for autism and developmental delays for children in medicaid programs.
Sponsors: Senate Committee on Health Care (originally sponsored by Senators Frockt, Becker, Mullet, Miloscia, Jayapal, Dammeier, Kohl-Welles, Litzow, Pedersen, Hatfield, Keiser, Darneille, Rivers, McAuliffe, Hasegawa, Rolfes, Conway and Chase).
Brief Summary of Substitute Bill |
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Hearing Date: 3/25/15
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.
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 of the American Academy of Pediatrics, as they exist on the effective date of the act (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.
Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.