During the week of March 20-23, the Iowa Senate acted on bills impacting autism and congenital cytomegalovirus (CMV). The autism legislation now goes to the Governor for his signature, and the CMV bill moves onto the Iowa House for its consideration. Here’s a summary of the two bills.
Insurance coverage for applied behavior analysis. The Senate unanimously approved House legislation, HF 215, that expands insurance coverage for applied behavior analysis to treat autism spectrum disorder. The bill requires that certain individual and group health insurance policies for public employees who are not state employees cover this treatment for children under 19 years old. The treatment must be provided by a board-certified behavior analyst or by a licensed physician or psychologist. The bill allows insurers to set annual maximum benefits that are not less than $30,000 for a child through age 6, $25,000 for a child 7 through 13, and $12,500 for a youth 14 through 18. Insurers may also impose deductibles and coinsurance charges. The bill becomes effective on January 1, 2018.
Cytomegalovirus education and testing. The Senate unanimously approved legislation (SF 51) to expand education about and testing for congenital CMV, which is a virus infecting individuals of all ages. While infected adults usually have no signs or symptoms, the virus can have profound and long-term effects on newborns born with the virus, acquired by transmission from their mothers. The CDC estimates that one in 150 newborns are born with congenital CMV. Most showing no signs or effects, but some do and suffer any of several health effects, including vision and hearing loss, intellectual disability, muscle weakness, small head size, seizures, and death.
Determining the existence of congenital CMV presents challenges. Testing for congenital CMV must occur with the newborn’s first three weeks and can be done from the newborn’s saliva or urine. In the absence of a clear indicator of the disease, SF 51 requires testing if a hospital’s initial newborn hearing screening indicates the newborn a hearing loss – which is a potential, but not certain, indicator of congenital CMV.
The Iowa-AAP registered undecided on SF 51 and, after consultation with state and national experts, issued a statement expressing support for and concern over provisions in the legislation. In the absence of statewide standardized testing, the Iowa-AAP statement recommends offering, but not mandating, congenital CMV testing to parents of infants who fail the newborn hearing screen, with the medical provider determining the test based on available resources. Iowa-AAP also recommends that, “Targeted testing should be done in such a manner that the medical community can gather safety, incidence, efficacy and cost effectiveness data to improve diagnosis and treatment.”
The bill has an education component, which Iowa-AAP supports. The bill requires the Iowa Department of Public Health to collaborate with health organizations to approve and publish information on congenital CMV, to be distributed to pregnant women, attending health care providers, and child care organizations. SF 51 also provides that health professionals who conduct the mandated test provide information to a newborn’s parents regarding congenital CMV, early intervention, and treatment resources and service.
The House has referred the legislation to its Commerce Committee.
Update: The Governor signed the autism bill on March 30. House approved the CMV bill on April 6, and the Governor signed it into law on April 20.