House lawmakers unanimously approved a bill to mandate most private insurers to cover medically necessary behavioral therapy for children with autism. The vote, 100 to 0, sent a strong message to autism advocates their voices were heard.

Rep. Jim Patterson, R-Meridianville, sponsored the bill, HB284, saying he wants to do the right thing for families who need help paying for the sometimes expensive therapy.

Introducing the bill on the House floor, Patterson said, "We're going to do something good for families in Alabama. This is what we come to Montgomery to do."

Alabama is one of five states with no requirement that insurance companies cover applied behavior analysis (ABA), the most common and scientifically supported treatment for autism.

Rep. Jack Williams, R-Vestavia Hills, worked to negotiate a compromise bill to contain costs while providing medically necessary services.

Williams added caps on coverage based on a person's age. There are higher caps for younger children, Williams said, because the earlier therapy can be started, the better the outcome.

The annual coverage caps are:

Ages 0 to 9: $40,000

Ages 10 to 13: $30,000

Ages 14 to 18: $20,000

Age 19 and over: $10,000

Those caps were constructed to coincide with school transitions, Williams said.

If the cost of providing autism therapy increases health insurance premium costs by more than one percent, an employer can opt out of providing that coverage, Williams said. That additional measure was included to address concerns of businesses and insurance representatives, Williams said.

Williams and Patterson took turns fielding questions from lawmakers.

Lawmakers thanked Patterson for bringing the bipartisan bill to the floor, and agreed with Patterson that the purpose of the bill is to help families and children.

The cost of providing coverage has been the subject of debate in recent weeks. Currently families are paying out of their pockets for the coverage, which can be expensive for children receiving many hours of therapy.

Robert Luckhardt of Birmingham attended Thursday's vote in Montgomery, and said he is happy about the House passing this bill. His 4-year-old son has autism and receives behavioral therapy at a cost of $20,000 to $40,000 a year, which Luckhardt says could mostly be covered by insurance if the bill becomes law.

Luckhardt said if his son had cerebral palsy or was diabetic, insurance would cover treatment. "But he's not covered for some reason because it's autism, and I don't know why. It's a medical condition," he said.

"We're taking a tremendous burden off of the Education Trust Fund," Williams said, as schools are paying for necessary therapy when children are in special education.

The bill requires annual reporting on the cost of therapy, similar to other states like Missouri.

Some lawmakers questioned whether the cost to provide coverage would be too high.

Forty-five states already provide insurance coverage for autism therapy. Advocates have cited numbers from actual claims data as evidence that costs could be as little as 32 cents per member per month to as high as one dollar per member per month, much lower than costs cited by insurance giant Blue Cross and Blue Shield of Alabama.

Rep. Anthony Daniels, D-Huntsville, added an amendment requiring Medicaid to cover the therapy in Alabama, even though federal law already requires autism therapy to be covered by Medicaid. Lawmakers questioned why Alabama Medicaid isn't already covering it.

Families wearing red "#AutismMatters" shirts, a play on Blue Cross and Blue Shield of Alabama's "We cover what matters" campaign, watched lawmakers from the gallery. As advocates for the bill, they purchased billboards and contacted legislators, pushing for passage.

Both the Business Council of Alabama and Blue Cross and Blue Shield of Alabama oppose the bill on principle, questioning whether businesses can afford the rising costs associated with insurance mandates.

In a statement to AL.com, Blue Cross and Blue Shield of Alabama communications director Koko Mackin said, "Blue Cross believes that employers who provide the jobs within our state and offer healthcare coverage for their workers should be the ones to determine their employees' benefits, not the legislature."

Dr. Bama Hager, director of policy and programs for the Autism Society of Alabama attended Thursday's vote and said, "The autism community is thrilled with the overwhelming response from the House of Representatives for the state of Alabama. We're looking for a similar response from our Senators."

The bill now heads to a Senate committee.

Updated 10 p.m. to include reaction from Luckhardt, Williams, and Hager and to add details of the bill passed by the House.