Excellent WA Article Covering the Issues of Treatment & Coverage

REMINDER: GET YOUR CALLS, EMAILS AND TESTIMONY
IN SUPPORT OF HB 3000 : Requires health insurers and state medical assistance program to reimburse for diagnosis and treatment of autism spectrum disorder.
IN TODAY!

The bill MUST BE approved in the House Health Care Committee to have a chance to go to the full Oregon House! See yesterday's post for who and how to contact.

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Excellent WA article summing up the situation and the points of view; while from our neighbors to the north, the issues are the same in Oregon.

Popular autism treatment often goes uncovered
By DEBBIE CAFAZZO, The News Tribune
October 12, 2008, updated Nov. 21, 2008

Talking points from the story:

INSURERS: Argue autism treatments aren't really medical, but are more educational and that education is the responsibility of the public schools. Can't cover teachers or paraprofessionals or parents who have training in ABA. Medical and rehabilitation services through licensed providers covered [pediatrician, psychologists, OT, PT, Speech].
[Comments: Autism is a medically defined and diagnosed disorder. The state can, and has in those states that have already passed such mandates, assist in determining competencies of service deliverers, and many of the mandate bills include such provisions, including those who are Board Certified Behavior Analysts , awarded certified status dependent on meeting conditions of required education, practical supervised experience, passage of an examination and ongoing education in applied behavior analysis, The licensed professionals cited by the insurance representatives, while competent in their own subject area, may not have appropriate or specific training in ABA. The services of OT, PT and Speech are necessary as part of a multidisciplinary treatment team, but to deliver behavior analytic treatment, the team must also include behavior analysts to supply competently delivered applied behavior analysis.]


SCHOOLS: Schools can't go it alone. The Federal government does not provide enough funding through IDEA, and local funds are insuffient as well. Children would be unlikely to get intensive 1:1 ABA. Not something one agency is responsible for and needs multiprong approach.
[Comments: IDEA is now and historically underfunded. Local funds have multiple demands, and are not always stable, as well as insufficient. Underproviding therapy by lack of intensity has been shown to undercut effectiveness of therapy, with threshholds where a "little" ABA is not that different from "no" ABA. The schools have a valid point that they are unreasonably expected to deliver behavioral health for a complex medical disorder requiring intensive treatment, without support of the usual medical entitities. ]


FAMILIES : Spending through IRAs, spending through savings, cutting back on personal expenditures, but seeing big benefits of ABA therapy. Sometimes have to stop because they no longer can afford. One spouse has to stop working to take care of the child because professional services not provided. The insurance covered services of OT, PT and speech through licensed providers have per year visit limits, so they have to cut back or suspend treatment when coverage ends until next eligibility period.
[Comments: Families purchase or count on health insurance as part of employment package in anticipation of avoiding financial disaster in the event of a catastrophic medical event. Current situation is that they can have health insurance and STILL have to suffer financial disaster because treatment excluded, or face the frustrating scenario of knowing they will receive less than the recommended hours of therapy because of limits in a quarter or year. Equivalent would be rationing medication for a chronic condition or giving partial treatment, or suspending treatment from time to time for an acute condition--expensive and less effective because insufficient].


SOME POLITICIANS: Schools already have multiple demands and kids can't be left to be cared for by the schools. Mandating coverage treatments and ABA treatment ultimately saves taxpayer dollars because early treatment reduces life risk of being permanently dependent [at higher cost] on the state as adults, and may allow mainstreaming in typical schools by 8 or 9. Saves money in the long run.
[Comments: These politicians are taking the long, and arguably, the correct view on social policy. Access to health care is a social question. From a financial and societal cost view, sufficient expenditure upfront for competent and necessary medical treatment can reduce lifelong cost per child/person by millions of dollars over the lifespan, and at current conservative prevalence of 1/150 this longterm cost will be a potentially frightful public expenditure. One might also argue that it keeps parents in the workforce, reducing their lost revenue, and with better outcomes, the children have higher probability as future taxpayers or at least require reduced public support as adults.]