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Role of Health Insurance
In July 2010, the Oregon Commission on Autism Spectrum Disorders announced the formation of a new subcommittee to focus on Role of Health Insurance, and began accepting applications for potential participants. The subcommittee membership includes family members, physicians, administrators, clinicians, and educators. The subcommittee held an introductory meeting on August 23 and have since been actively working to develop recommendations on this important issue.
Charge:
Draft - Define the role of the private and public health insurance system in the care and treatment of individuals on the Autism Spectrum across the age span.
Goals
- Analyze the role and implementation of public and private health insurance in other states as it relates to children on the Autism Spectrum.
- Identify which services appropriately fit within the responsibility of health insurance.
- Specify the best available evidence supporting that this service is effective
- Identify the criteria for medical necessity for each service.
- Make recommendations related to the providers of services, including the issues of capacity development. Recommendations should address each type of service (e.g. screening, diagnosis, specific treatment, medication, nutritional supplements)
- What credentials are necessary to prescribe / authorize services?
- What credentials are necessary to monitor implementation and evaluate progress?
- What credentials are necessary to provide services?
- Specify measures for determining success of service(s)
- Map a structure and process for coordination and integration between health care, education, publically funded services and privately provided services.
- Determine appropriate limits on services under health insurance. States with mandates have created limits based on:
- Age
- Age at diagnosis
- $ amount per year or lifetime
- Hours of service per week
Additional References:
OCASD_Role_of_Insurance_Subcommittee_Guiding_Principles.pdf
OCASD_Role_of_Insurance_Member_Roster.pdf
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