Families of the autistic struggle with care and costs
by Bryan Denson, The Oregonian Tuesday April 28, 2009, 7:22 PM
Photos by Benjamin Brink/The Oregonian
Annotated excerpts with links to additional info; comments in red.
by Bryan Denson, The Oregonian Tuesday April 28, 2009, 7:22 PM
Photos by Benjamin Brink/The Oregonian
Annotated excerpts with links to additional info; comments in red.
"Joe Joe McHenry, 4, uses toys to learn pronouns during a recent morning session with autism behavioral therapist Emily Hoyt. Joe Joe's mom, Lisa McHenry, says the intensive therapy has been vital to his development.
...But McHenry was astonished to learn that her health insurance didn't cover a penny of the expensive treatment...
Autism is also on center stage in Salem, and for good reason. U.S. prevalence of the brain disorder is about 1 in 150, according to the Centers for Disease Control and Prevention [1], but some estimates based on school data put Oregon's rate as high as 1 in 87 [2]. Policymakers warn of an approaching "autism tsunami" that will wash over the state's already troubled educational systems...
autism advocates and insurers are squared off over House Bill 3000. The proposed law would require insurance companies to pay up to $36,000 a year for Oregonians younger than 21 enrolled in the kind of intensive behavioral therapy Joe Joe McHenry undergoes....
[Blog Author note: The key phrase being "up to". While the most challenged children may require the entire amount specified under the cap, many children will probably require less and the cost should decrease with improvement through treatment, since the goal is to intervene early, and enable as many children to enter elementary school with no, or minimal aids. Some students will require more support and intervention. Cost analyses done by the actuarial firm of Oliver Wyman Actuarial Accounting, Inc., cites figures of a 0.1% increase in per policy cost in Texas since the passage of their mandate in 2007, with estimated per-policy costs for other states well under 1% (range 0.36- 0.75%)[3][4][5][6]. This corroborates with data from the states of Indiana and Minnesota which have had this coverage for several years [7]. In South Carolina, since passage of their autism insurance reform mandate, some insurers who were not required to provide the coverage under the law are choosing to do so voluntarily [8]. Canada's fiscal study of current cost vs. future savings assessed that current investment in intensive behavioral therapy will represent a future fiscal savings. [9] ]
Insurance companies generally pay for drugs that improve symptoms of autism. But they have been slow to embrace the concept of paying for the kind of behavioral therapy Joe Joe undergoes, describing it as not medically necessary [10] or experimental in nature [11].
This bewilders Laura Schreibman, Ph.D., a veteran autism researcher at the University of California at San Diego [12]...Though scientists are far from agreeing on the origins of autism, Schreibman believes it is a neurodevelopmental disorder present from birth that appears to be genetic. It is clearly a medical issue, she said...
FULL ARTICLE
...But McHenry was astonished to learn that her health insurance didn't cover a penny of the expensive treatment...
Autism is also on center stage in Salem, and for good reason. U.S. prevalence of the brain disorder is about 1 in 150, according to the Centers for Disease Control and Prevention [1], but some estimates based on school data put Oregon's rate as high as 1 in 87 [2]. Policymakers warn of an approaching "autism tsunami" that will wash over the state's already troubled educational systems...
autism advocates and insurers are squared off over House Bill 3000. The proposed law would require insurance companies to pay up to $36,000 a year for Oregonians younger than 21 enrolled in the kind of intensive behavioral therapy Joe Joe McHenry undergoes....
[Blog Author note: The key phrase being "up to". While the most challenged children may require the entire amount specified under the cap, many children will probably require less and the cost should decrease with improvement through treatment, since the goal is to intervene early, and enable as many children to enter elementary school with no, or minimal aids. Some students will require more support and intervention. Cost analyses done by the actuarial firm of Oliver Wyman Actuarial Accounting, Inc., cites figures of a 0.1% increase in per policy cost in Texas since the passage of their mandate in 2007, with estimated per-policy costs for other states well under 1% (range 0.36- 0.75%)[3][4][5][6]. This corroborates with data from the states of Indiana and Minnesota which have had this coverage for several years [7]. In South Carolina, since passage of their autism insurance reform mandate, some insurers who were not required to provide the coverage under the law are choosing to do so voluntarily [8]. Canada's fiscal study of current cost vs. future savings assessed that current investment in intensive behavioral therapy will represent a future fiscal savings. [9] ]
Insurance companies generally pay for drugs that improve symptoms of autism. But they have been slow to embrace the concept of paying for the kind of behavioral therapy Joe Joe undergoes, describing it as not medically necessary [10] or experimental in nature [11].
This bewilders Laura Schreibman, Ph.D., a veteran autism researcher at the University of California at San Diego [12]...Though scientists are far from agreeing on the origins of autism, Schreibman believes it is a neurodevelopmental disorder present from birth that appears to be genetic. It is clearly a medical issue, she said...
"There's no other form of treatment for children with autism that's been demonstrated -- I mean empirically demonstrated [13] -- to be effective with these kids," Schreibman said. "I just don't know how much research and how much literature has to amass [14] before insurance companies are going to say, 'Yeah, OK.'"
FULL ARTICLE
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- Prevalence of the Autism Spectrum Disorders in Multiple Areas of the United States, Surveillance Years 2000 and 2002. Centers for Disease Control and Prevention, Department of Health and Human Services. Date March 11, 2009 Content source: National Center on Birth Defects and Developmental Disabilities. Accessed April 28, 2009.
http://www.cdc.gov/ncbddd/dd/addmprevalence.htm - "Services Aren't Keeping Up With Autism". Oregon Public Broadcasting (OPB) News. August 20, 2008.
Accessed April 28, 2009.
http://news.opb.org/article/2871-services-arent-keeping-autism/ - Actuarial Cost Estimate: Connecticut Senate Bill 301 An Act Concerning Health Insurance Coverage for Autism Spectrum DisordersOliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA
From Autism Votes - Actuarial Cost Estimate: Georgia Senate Bill 161 An Act Relating to Insurance Coverage for Autism Oliver Wyman Actuarial Consulting, Inc., Marc Lambright, FSA, MAAA, March 2, 2009
From Autism Votes - Actuarial Cost Estimate: Kansas Senate Bill 12 An Act Relating to Insurance Coverage for Autism Oliver Wyman Actuarial Consulting, Inc., Marc Lambright, FSA, MAAA, March 2, 2009
Addendum
From Autism Votes - Actuarial Cost Estimate: Missouri Senate Bill 167 – An Act Relating to Coverage for the Diagnosis and Treatment of Autism Spectrum DisordersOliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA.
From Autism Votes Presentation by Lorri Unumb, Esq., Senior Policy Analyst, Autism Speaks, in public testimony to the Oregon House Health Care Committee, April 8, 2009.
- Lorri Unumb, Esq., Senior Policy Analyst, Autism Speaks. (Personal communication)
- Motiwala, S. S., Gupta, S., & Lilly, M. B. (2006). The cost-effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario [Canada]. Healthcare Policy, 1(2), 135-151.
- One definition: MEDICALLY NECESSARY – means any care, treatment, intervention, service or item which will or is reasonably expected to do any of the following: (i) prevent the onset of an illness, condition, injury, disease or disability; (ii) reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury, disease or disability; or (iii) assist to achieve or maintain maximum functional activity in performing daily activities."
- Petitioner File No. 85641-001.STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE SERVICES Before the Commissioner of Financial and Insurance Services. Issued and entered 11/27/2007.
In the matter of XXXXX v Blue Cross Blue Shield of Michigan, Respondent
http://www.michigan.gov/documents/dleg/85641_BCBSM_11-27-07.pdf_222301_7.pdf
Accessed April 28, 2009.
Determined that ABA was an appropriate covered benefit, not educational and not experimental. - UCSD Autism Research Program, University of California, San Diego
Accessed April 28, 2009. - Applied Behavior Analysis and Neurodevelopmental Disorders: Overview and Summary of Scientific Support. Louis P. Hagopian & Eric W. Boelter. The Kennedy Krieger Institute and Johns Hopkins University School of Medicine. Accessed April 28, 2009.
http://www.kennedykrieger.org/kki_misc.jsp?pid=4761 - Summaries of Research Evidence EIBI Comprehensive Interventions. p. 9-11, 13-16, from The Science and Art of Behavioural Autism Interventions: Designing Programs with Evidence and Compassion. Shahla Alai-Rosales, Ph.D., BCBA. February, 2009.
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