Gov. Bob McDonnell is expected today to reveal proposed changes to a bill requiring insurance coverage of autism treatments, and some could be substantial alterations to what the General Assembly passed.

Conversations were continuing as of Tuesday between the governor's office, lawmakers and interested parties about possible changes to a measure that would require coverage of autistic children ages 2 to 6.

Advocates of the bill said some significant tweaks could be "deal breakers."

The amendments floated in the past week range in scope, from technical to more substantial, including changes in who could supervise treatment and when the law would take effect, according to those familiar with the proposals.

What McDonnell offers remains to be seen; he had until midnight Tuesday to act on legislation. That means action on all other measures, including budget amendments, will be revealed today.

"I'm very sympathetic to the plight of people with autistic children; the numbers are significant in our country and in our state, and the costs without insurance of attending to their needs is significant over their life," McDonnell said on WTOP radio Tuesday.

"I'm also concerned about more unfunded mandates on business and on individuals." Especially, he said, in light of the federal health care overhaul.

"We have talked to a number of the proponents and are looking at a series of amendments that we'll be offering tomorrow on that bill and hopefully be accepted by the General Assembly."

The measure that passed the legislature would require coverage of treatment for autistic children ages 2 to 6 and is narrower in scope than previous efforts that sought to cover all developmental disabilities over broader age ranges without a limit on coverage.

The law would cap annual costs at $35,000. It would not apply to self-insured companies and would exempt small businesses with 50 or fewer employees. It would cover state employees.

The National Federation of Independent Business, the Virginia Chamber of Commerce and tea-party groups strongly oppose the measure, arguing that the law would be a costly mandate on businesses and taxpayers.

The legislation passed both chambers with substantial support. The Senate version of the bill passed 71-27 in the House and 29-8 in the Senate. The House version of the bill passed 73-24 in the House and 27-11 in the Senate.

Lawmakers can either accept or reject the governor's amendments. If the amendments are agreed to by the House and Senate, the amended bill becomes law.

If the amendments are rejected, the original bill returns to the governor, and he can sign or veto the bill. Or, if lawmakers reject his amendments, they can pass the bill as it left the assembly if two-thirds of the members of each body agree.

In the House, a two-thirds vote would mean 67 members and in the Senate, it would take 27.

"The leadership in the General Assembly has worked very hard on this issue, and we're confident that a good outcome can be reached," said John W. Maloney, autism advocate with Virginia Autism Project.

If Virginia adopts the law, it would join 24 other states that require insurers to provide coverage for the treatment of autism. Arkansas is the latest state to join the list, where the governor signed its bill into law this month.

Over the weekend, McDonnell signed a bill allowing the state to maintain some control over billboards that show alcohol advertisements.

omeola@timesdispatch.com

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