HomeMy WebLinkAboutResolutions - 2012.11.01 - 20584N RESOZRCES COVIIVIITTEE
November 1,2012
MISCELLANEOUS RESOLUTION #12278
BY: HUMAN RESOURCES COMMITTEE — JOHN SCOTT, CHAIRPERSON
IN RE: HUMAN RESOURCES DEPARTMENT / BENEFITS DIVISION — ADDITION OF AUTISM
SPECTRUM DISORDER COVERAGE TO COUNTY SELF-INSURED MEDICAL PLANS
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS Oakland County is continually reviewing and evaluating the benefit programs
offered to County employees: and
WHEREAS it is important to maintain a balance between the needs of the County
workforce and the needs of the County citizens; and
WHEREAS Michigan Public Acts 99 and 100 of 2012 mandate the coverage of Autism
Spectrum Disorders for insured medical plans beginning October 15, 2012; and
WHEREAS the County is self-insured for its Blue Cross/Blue Shield plans, so the
addition of this coverage to these plans is discretionary; and
WHEREAS the Autism Coverage Incentive Act PA 101 of 2012, requires that the
Michigan Department of Licensing and Regulatory Affairs to create and implement a program
through which self-insured plans can seek reimbursement for paid Autism Spectrum Disorder
claims; and
WHEREAS medical coverage under the County's HAP HMO plan is insured, therefore
Autism coverage will automatically be added to that plan pursuant to PA 100 of 2012; and
WHEREAS the Centers for Disease Control and Prevention estimates that
approximately one in 88 American children are diagnosed with Autism Spectrum Disorder; and
WHEREAS the CDC states that early diagnosis and intervention can lead to improved
outcomes.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners authorizes the addition of coverage, as provided through Blue Cross/Blue
Shield of Michigan for Autism Spectrum Disorder, to the Oakland County medical plans for
eligible County employees.
BE IT FURTHER RESOLVED that these proposed changes apply to all non-represented
employees and represented employees whose bargaining agreements provide for these
changes, effective January 1, 2013.
Chairperson, on behalf of the Human Resources Committee, I move the adoption of the
foregoing resolution.
Human Resources Committee Vote:
Motion carried unanimously on a roll call vote
BCBSIVE and BCN Autism Benefit
Frequently Asked Questions
August 24, 2012
0.1. Are all customer groups required to after coverage for the diagnosis and treatment of
autism spectrum disorders?
A.1. No, The mandate applies only to fully-insured groups and individual plans. The mandate does not apply to
self-funded groups, but groups that aren't required to offer the coverage may opt to do so. Blue Cross and
BCN will provide more information at a later date on how self-funded groups can offer coverage.
0.2. What conditions are included in autism spectrum disorders?
A.2. The legislation refers to autism spectrum disorder as defined by the American Psychiatric Association
Diagnostic and Statistical Manual, which includes:
• Autistic disorder
• Asperger's disorder
• Pervasive developmental disorder not otherwise specified.
0.3. What benefits are covered?
A.3. Mandated benefits for BCESM and BON fully insured groups are shown below:
1
1 BCBSM Group Coverage BON Coverage
1Coverage when billed • Applied behavior analysis • Applied behavior analysis
with a diagnosis of autism • Physical therapy - Physical therapy
spectrum disorder • Speech therapy • Speech therapy
• Occupational therapy • Occupational therapy
• Nutritional counseling • Nutritional counseling
BCBSM currently covers outpatient mental BCN currently covers outpatient mental '
health services and other medical services health services for members with an ASD
for members with an ASD diagnosis diagnosis
Annual dollar limits* $50,000 annual benefit limit for the $50,000 annual benefit limit for the
services noted above services noted above
Age limits* Through age 18 Through age 18
Mandated services not All standard mental health services and All standard mental health services and
subject to dollar and age diagnostic services diagnostic services
limits
Cost share All services to diagnose or treat ASD will ASD-related physical, occupational, and
be subject to the member's medical cost speech therapy services will be subject
share, as applicable. If the group has to medical outpatient therapy benefit and
a mental health parity rider, services to the applicable deductible, copayment
diagnose or treat ASD will be subject to or coinsurance. Other outpatient ASD-
the cost-sharing requirements in that rider, related services will apply the primary
care physician copay/coinsurance and
deductible when applicable.
Prior approval Required only for applied behavior Required for all services
requirements analysis
• BCBSM members receiving services other than applied behavior analysis (ABA) to treat ASD do not need to
receive the ASD diagnosis from a BOBSM participating provider. BON members must go to a provider in the
BON network.
- Before seeking applied behavior analyst services the member is required to QO to a BCESM- or BON-approved
autism evaluation center, or PAEC, to confirm a diagnosis of ASD.
• For applied behavior analysis treatment to be payable, the AAEC must confirm the ASD diagnosis and provide
a treatment plan containing a comprehensive set of treatment recommendations for the member, including a
recommendation for applied behavior analysis.
Continued on reve
• If applied behavior analysis treatment is recommended by the AAEC, the member must seek services from a
board-certified behavior analyst, or BCBA, for the treatment to be payable. The analyst also must obtain prior
approval from BOBSM or BCN to provide applied behavior analysis services.
• For BOBSI'vl ti-ie BC:BA may be nonparticipating.
• For BON services must be obtained from a BON network provider.
• BOBSM does not require prior approval for physical therapy, speech therapy, occupational therapy, nutritional
counseling or mental health counseling.
• For BON, all services will require prior approval.
*These limits may be waived on an individual basis when BCP.,SM/BON determines further treatment is medically
necessary
0.4. Will members have autism coverage both in and out of their networks?
A.4. Network requirements remain the same and cost sharing will continue for in-network versus out-of-network
services where applicable. BON Members should be aware that, in most instances, out-of-pocket costs
for out-of-network medical care can be substantial. BON and BCBSM members should always confirm the
provider's and facility's network participation in advance.
0.5. Does the $50,000 limit applied to autism benefits conflict with the federal Mental Health Parity Law?
A.5. No. The $50,000 limit for the autism benefit will not preclude members from obtaining medically necessary
services to diagnose and treat ASD. Once 550,000 has been paid for autism benefits, BCBSM and BON will
allow additional payments to be made upon the request of the member's provider. Additional services will
require approval.
0.6. Does the age limit applied to autism benefits conflict with the federal Mental Health Parity Law?
A.6. No. The age limit for the autism benefit will not preclude members from obtaining medically necessary
services to diagnose and treat ASD. Once the member is beyond age 19, BOBSEV1 and BON will allow
additional payments to be made upon the request of the member's provider. Additional services will require
approval.
0.7. How do members find BCBSM- and BCN-approved autism evaluation centers?
Al. Beginning Oct. 15, 2012, members can go online and check the provider directory at bcbsm,com and
MiBCN.com/find . The listing of AAECs can be accessed at Approved Autism Evaivation Centers.
0.6. Will member premiums go up once autism coverage is available?
A.8. No. There will be no increase in member premiums as of Oct. 15, 2012.
The information in this document is based on Michigan Blues review of the applicable legislation and is not intended to impart
legal advice. Interpretations of this legislation may vary, and efforts will be made to present and update accurate information, This
overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual
circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice.
FISCAL NOTE (MISC . #12278) November 1, 2012
BY: Finance Committee, Tom Middleton, Chairperson
IN RE: HUMAN RESOURCES DEPARTMENT! BENEFITS DIVISION — ADDITION OF AUTISM
SPECTRUM DISORDER COVERAGE TO COUNTY SELF-INSURED MEDICAL PLANS
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above referenced
resolution and finds:
1. Michigan Public Acts 99 and 100 of 2012 mandate the coverage of Autism Spectrum
Disorders for insured medical plans beginning October 15, 2012.
2. One in 88 American children are diagnosed with Autism Spectrum Disorder and the CDC
states that early diagnosis and intervention can lead to improved outcomes.
3. The medical coverage under the County's HAP HMO plan is insured; therefore Autism
coverage will automatically be added to that plan pursuant to PA 100 of 2012.
4. The county is self-insured on the Blue Cross/Blue Shield plans so the addition of this plan is
discretionary.
5. The Autism Coverage Incentive Act PA 101 of 2012 requires the Michigan Department of
Licensing and Regulatory Affairs to create and implement a program through which self-
insured plans can seek reimbursement for paid Autism Spectrum Disorder claims.
6. These changes apply to all non-represented and represented employees whose bargaining
agreements provide for these changes, effective January 1, 2013.
7. The County cost to add Autism coverage to the county's self-insured medical plans is
estimated at $139,000 annually.
8. Sufficient funding for the increase is included in the FY 2013 Adopted Budget within the Fringe
Benefit fund; therefore no budget amendment is recommended.
FINANCE COMMIT_TEE
FINANCE COMMITTEE
Motion carried unanimously on a roll call vote.
Resolution #12278 November 1, 2012
Moved by Hoffman supported by Jackson the resolutions (with fiscal notes attached) on the amended
Consent Agenda be adopted (with accompanying reports being accepted).
AYES: Crawford, Dwyer, Gershenson, Gingell, Gosselin, Hatchett, Hoffman, Jackson, Long,
Matis, McGillivray, Middleton, Nash, Nuccio, Potts, Quarles, Runestad, Scott, Taub, Weipert,
Woodward, Zack, Bosnic, Covey. (25)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the amended
Consent Agenda were adopted (with accompanying reports being accepted).
I H !APPROVE THIS RESOLUTION
Ci-IR-F DEPUTY COUNTY EXECUTIVE
ACTING PURSUANT TO MCL 45.559A (7)
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Bill Bullard Jr., Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true
and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on November
1, 2012, with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at
Pontiac, Michigan this 1 st day of November, 2012.
R,Lf2i2, 094,
Bill Bullard Jr., Oakland County