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Parents and advocates for a bill requiring many insurance plans to cover autism therapy packed a committee meeting room an hour before the meeting.

((Mike Cason/mcason@al.com))

Facing a room full of parents and advocates, a Senate budget committee approved a bill to require some insurance plans to cover behavioral therapy for autism, but not before adding amendments that could slow final approval.

Also, budget committee chairman Trip Pittman, R-Montrose, said he was not certain he would take the normally routine step of signing the bill out of committee so it could be considered by the full Senate.

Pittman, who said he has concerns about the bill's costs to taxpayers, said late this afternoon he is expecting more negotiations.

"The bill has tremendous importance," Pittman said. "It has tremendous fiscal ramifications. There's a lot of emotion involved in the bill.

"There's a process with certain things the chairman can do, and as budget chairman I think it's important that we quantify this bill and make sure that it's a bill that we can sustain in the state."

The bill would require insurance plans to cover applied behavior analysis, which advocates and parents say is a vital therapy for helping children diagnosed with autism develop the skills they need to learn and communicate.

The therapy can be prohibitively expensive without insurance, and the lack of widely available insurance coverage in Alabama causes a shortage of providers and services, parents and advocates say.

It has become an emotionally charged issue in the State House.

Proponents and opponents gave widely varying estimates of costs during a public hearing before the budget committee last week.

Today, the committee room filled to standing room only more than 45 minutes before the meeting started.

Sen. Dick Brewbaker, R-Pike Road, said he and other senators have a commitment from Pittman to put the bill in position for consideration in the Senate.

"If that doesn't happen, the Senate is going to blow up," Brewbaker said. "We might as well just adjourn."

No more than five meeting days remain in the legislative session. Brewbaker said he did not think senators would give final approval to the General Fund budget if Pittman holds the autism bill in committee. If the budget doesn't pass, lawmakers would have to return in a special session.

"People are willing to come back in a special if that's what it takes," Brewbaker said.

That said, Brewbaker said he expected Pittman to report the bill on Thursday.

"In the six years I've known him, his word has been good," Brewbaker said.

Brewbaker said senators all know families in their districts who are affected by autism.

Former state Sen. Myron Penn and his wife, Karen, were at the State House today. Their son, Corde, 6, was diagnosed with autism at age 3 and recommended for applied behavior analysis. They saw results almost immediately.

The care is expensive, about $120 an hour, they said, but vital. They pay out of pocket because their insurance policy does not cover it.

They encounter other parents with autistic children who can't afford the level of care Corde is receiving.

"They scrape together a couple of hours, if they can," Karen Penn said.

The bill, by Rep. Jim Patterson, R-Meridianville, passed the House by a vote of 100-0 last month.

Today's approval by the Senate Finance and Taxation General Fund Committee could put the bill in position for a vote in the Senate next week if Pittman signs it out of committee on Thursday.

The bill would also have to return to the House because of the changes made in committee today.

Pittman offered several amendments. The committee rejected some but approved two, including one that limited the mandate for insurance coverage to children age 16 and younger.

The second amendment limited the mandate to insurance plans for companies with at least 51 employees.

After amending the bill, the committee approved it by a vote of 14-2. The only no votes were by Pittman and Sen. Paul Sanford, R-Huntsville.

Sen. Bill Holtzclaw, R-Madison, expressed concern that the amendments could hinder final passage.

"We basically have a runner stranded on third base and we need to get him on in," Holtzclaw said.

Asked about Pittman's comments that he might not sign the bill out of committee, Holtzclaw said in a text message: "It's been an emotional day but I would hope he does the right thing and does not prevent this bill from coming up for a vote."

Sen. Cam Ward, R-Alabaster, a supporter of the bill, said he believed the amendments were intended to slow the bill down so that the session could end before it passes.

"Momentum is on the side of the people who want this coverage for their kids," Ward said. "If it wasn't on their side, you would never have procedural gimmicks like that done."

Patterson, the House sponsor, said he was still optimistic.

"I think we're close, and I think we're going to be successful," Patterson said.

At today's committee meeting, Pittman offered a substitute bill that made several changes. For one, it would have taken the insurance plans for state employees and education employees out of the coverage mandates. Pittman said the boards that govern those plans should have a chance to study what the mandate would cost.

"Those familiar with state government know we have a cobbled together state budget built on a foundation of sand with lots of moving parts, with all the reforms going on at the federal level," Pittman said.

"For us to take on a program without accounting for certain restrictions or limits, to me would be totally fiscally irresponsible."

The committee rejected Pittman's substitute.

Blue Cross Blue Shield of Alabama, the state's largest insurer, opposes the mandate.

In a letter to Pittman, the company committed to providing autism coverage for children up to age 16 in its large, underwritten group plans covering 50 or more employees.

Patterson and other supporters of his bill said the mandate was still needed.

Updated at 7:32 a.m. on May 11 to describe second amendment added to the bill.