Dive Brief:
- Missouri Gov. Jay Nixon announced this week that Aetna, one of the largest health insurance providers in the state, has been slapped with a $4.5-million fine for failing to cover autism health benefits in some instances.
- The state passed a law in 2010 that made it mandatory for health insurers to cover the diagnosis of autism as well as specific treatments.
- The governor's statement says Aetna agreed to pay the $4.5-million fine.
Dive Insight:
The situation has a sense of déjà vu. According to the St. Louis Post-Disptach, this is the second time Aetna has been hit with a fine related to autism coverage. In 2012 Missouri fined Aetna $1.5 million for infractions that included a lack of coevrage for some specific autism therapies. Aetna paid the fine in that case as well.
The company now faces more than a fine, however. The governor's statement says Missouri will monitor Aetna for three years to ensure compliance, or Aetna could lose its license to operate in the state.
Daniel Unumb, executive director of Autism Speaks' Legal Resource Center, told the paper that the group often sees "heel dragging" by insurers and recommends this type of strong state enforcement of coverage requirements.