"A tactic used by insurance companies to deny expensive behavioral therapy to autistic children has been deemed illegal by a Los Angeles judge..."
Parents of autistic children gathered this morning at Consumer Watchdog's Los Angeles headquarters to announce a lawsuit against Governor Schwarzenegger's administration for allowing health insurers to refuse to pay for Applied BehaviorFULL STORY AT THE HUFFINGTON POSTal[sic] Analysis ("ABA"), an essential treatment for autism, in plain violation of the California Mental Health Parity Act.
Independent panels of doctors paid by California had been ruling in every autistic child's case that the ABA treatment was medically necessary [my emphasis], so insurers changed the rules of the game with the help of the Schwarzenegger administration. The insurers simply claimed the treatment wasn't covered, because it was educational in nature, and therefore independent panels of medical reviewers no longer had the power to overrule the insurance bureaucrats. (...)
"...but we will point out that in places like VA, where one of our leading developmental pediatricians comes from, the schools do much more on this [autism], and they feel that they have not even begun to reach the level of what their side of the bargain should do in this...".And my reaction at the time was,
[Blog author note: Without the particular significance or special insight involved, the description of what was said by the colleague, "leading", or not is what is known as "anecdotal" or "testimonial". It may well be that VA schools are better, or not. If such was sufficient as evidence, the matter at hand, then we could dispense with experimental design altogether. The point is moot and irrelevant of the merits of this legislation. And if retaining it to the question of schools, if the anecdote that VA schools are doing much more but only scratching the surface, what does that say about the level of therapy in any venue available in Oregon?..."So the headline from Virginia that caught my attention was,
"The state [VA] does a poor job of providing services to people with autism, the legislature's watchdog group said today...Parents seeking benefits for autistic children, and insurance lobbyists gearing up to oppose the possibility of mandated insurance benefits that might include autism treatments, filled a room at the General Assembly Building to hear the report...JLARC [Joint Legislative Audit and Review Commission] began the study last year. Its first report recommended that health insurance require that autism treatment be covered. Under heavy pressure from insurance interests and small-business owners, the General Assembly rejected the proposal..."[Blog author: So that was what was really going on with insurance proposals in Virginia, and what does the JLARC report say (keeping in mind that the conditions in Virginia were presented as superior to that in Oregon)?]
CHAPTER 2: ASDS CAN OFTEN BE EFFECTIVELY TREATED, RESULTING IN COST SAVING
"...Several treatment approaches have been scientifically shown to meaningfully improve the outcomes of individuals with ASDs, including the commonly referenced applied behavioral analysis (ABA) method. In particular, most young children with ASDs who participate in intensive early intervention programs based on ABA principles experience improvements, with almost half achieving normal levels of functioning and another 40 percent realizing moderate gains. According to cost-benefit analyses, providing intensive treatment to young children can significantly reduce public costs by decreasing the need for special education and other forms of public assistance, with savings likely to accrue over the lifetime of individuals with ASDs. While many approaches have been categorized as effective for treating ASDs, research indicates that packaged programs with a pre-determined curriculum, such as ABA, appear to have more promising results than programs that rely on a more informal mix of interventions..."
Chapter 2: Autism Spectrum Disorders Can Be Effectively Treated, Producing Cost Savings
p.11, "... The largest body of research exists for interventions based on applied behavior analysis (ABA). ABA-based interventions are supported by approximately 30 years of research pointing to their effectiveness and have been accepted by much of the medical community as effective techniques for treating ASDs, along with several other interventions. Further, research indicates that treatment is beneficial for many and could result in long-term savings of public resources over these individuals’ lifetimes...
See Figure 2: Interventions Have Been Categorized Based on Category: Scientifically Based Practices
"Significant and convincing empirical efficacy and support:
Applied Behavior Analysis, Discrete Trial Training. Pivotal Response Training, LEAP"
p.16, "...By applying the methodology used in the Pennsylvania and Texas studies to Virginia-related data, JLARC staff estimate that the Commonwealth could save approximately $137,400 in special education costs per student with an ASD if EIBI was consistently provided. In fact, the analysis indicates that Virginia could realize savings as long as at least 42 percent of students with ASDs who received EIBI make moderate improvements (require less intensive services and fewer supports), which is a substantially more conservative outcome than the outcomes reported in the research literature..."
p.33 -34, Table 8: Common Arguments Concerning Health Insurance Coverage for ASD-Related Therapies
[yin:] Many treatments are experimental, investigational, or unproven for ASDs. No treatment is known to be effective for all individuals.
[yang] Many in the medical community (including the U.S. Surgeon General, the Institute of Medicine’s National Research Council, and the American Academy of Pediatrics (AAP)), recognize certain therapies as research-based, including speech, occupational, physical, and behavioral therapies such as those based on the principles of applied behavioral analysis (ABA). Medical treatments are generally not effective for everyone who suffers from a given medical condition
Chapter 7: Improving the Delivery of Services to School-Age Virginians With ASDs
p.114, Specific “Packaged” Interventions Appear More Promising, but Many Schools Use the Mixed-Methods Approach
"...Because individualized educational programming often necessitates the use of multiple instructional strategies, Virginia schools commonly rely on a variety of approaches to serve students with ASDs. However, only a minority of schools report using comprehensive packages such as applied behavior analysis (ABA). Further, fewer than ten percent of schools use these packages as their preferred intervention, relying instead on a “mixed methods” approach to meeting the needs of students with ASDs, despite evidence that packages tend to yield better results (Chapter 2). The literature does note that a mixed methods approach could be just as effective as a package, in theory, but that it requires a degree of expertise, planning, and coordination that is often not present in Virginia schools..."Read the report.
"On June 3, 2009 S. 1169 was introduced by Senator Kirsten E. Gillibrand (NY), as the Senate-side companion resolution to the previously introduced H.R. 1600. Both bills would "amend title 10, United States Code, to provide for the treatment of autism under TRICARE..."
Full article:
Monday, June 8, 2009 Practitioner Issues in Behavior Analysis SIG Blog
NEWS: Federal S. 1169 joins H.R. 1600 to provide for the treatment of autism under TRICARE
"...Despite dutifully paying premiums to insure against the unthinkable that their child could be diagnosed with a disease or disorder, most parents of children with autism cannot get appropriate coverage to treat their child's medical conditions. Not because these parents didn't act responsibly and do their part but because insurance did not do their part...See the full article at the Huffington Post
Why should you care about their plight as an average tax paying citizen without a child with autism? It directly affects your own checking account...
No one would dream of treating a child with a life threatening illness at any less than what the doctor recommends. No one would ever expect that the public education system to be responsible for curing that disease and yet, insurance companies do just that...shirk their accountability to the education system instead of providing children with appropriate coverage when they are toddlers making them more likely to be mainstreamed into a regular education setting. Providing access to these treatments saves tax payer's dollars, creates new job markets and most importantly, gives these children an opportunity to become tax payers themselves one day with independent lives via a fiscally responsible solution to a growing societal issue..."
“It is hard to appreciate how much effort on the part of so many goes into passing a bill of this nature,” said Mike Bernoski, Executive Director of Texas Autism Advocacy. “The broad bipartisan support shows that Republicans and Democrats alike understand this is a family issue, and it moves Texas a significant step forward in its response to the growing crisis of autism.”This is Texas Autism Advocacy’s second successful push to secure better insurance coverage for children with autism.
“One in 150 children is diagnosed with autism. If we do not take care of our children now, we as Texans will suffer later,” Rep. Allen explained. “This bill will help the hardest working in Texas - those that deal with the challenges of raising a child with autism.”The Texas bill remains the only state insurance reform that has no dollar caps on the stipulated coverage which includes diagnostic testing, speech, OT, PT, as well as medical and behavior therapies.
“Early intervention has proven to be able to turn a child’s life completely around,” commented Senator Eddie Lucio Jr., “Now that we have a better understanding of the associated costs and benefits it is time to take the next step".
CARSON CITY, Nev.—Nevada lawmakers gave final approval Saturday to help children with autism by requiring health insurers to cover screening and treatment of the disorder..."
FULL POST San Jose [CA] Mercury News
http://www.mercurynews.com/breakingnews/ci_12437455
| AB162 | Requires certain policies of health insurance and health care plans to provide coverage for screening for and treatment of autism. (BDR 57-44) | ||
| Introduced On: Feb 12, 2009 | |||
| By: Ohrenschall Buckley Leslie Woodbury Conklin Aizley Anderson Arberry Atkinson Bobzien Carpenter Christensen Claborn Denis Dondero Loop Goicoechea Grady Hambrick Hardy Hogan Horne Kihuen Kirkpatrick Koivisto Manendo Mastroluca McClain Mortenson Munford Oceguera Parnell Pierce Segerblom Smith Stewart Horsford Schneider Lee Wiener Townsend Amodei Breeden Care Carlton Coffin Copening Nolan Parks Rhoads Woodhouse | |||
| Most Recent History Action: May 23, 2009 - Enrolled and delivered to Governor. | |||
Colorado becomes the 11th State to pass an autism treatment mandate
including Applied Behavior Analysis! Bill goes to the Governor for signature.
See the press release below
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FOR IMMEDIATE RELEASE
CONTACT:
Betty Lehman
Autism Society of Colorado
Cell: 303.898.7656
Betty@autismcolorado.org
www.autismcolorado.org
Colorado Legislature Passes Insurance Coverage for Treatment of Autism
Denver, Colorado, 5/5/09 – A landmark, bi-partisan bill expanding the treatment of autism was given final approval by the Senate and is on its way to the Governor. Senate Bill 244, sponsored by Senate Majority Leader Brandon Shaffer (D-Longmont) and State Representative Dianne Primavera (D-Broomfield) will require health insurance providers to cover assessment, diagnosis and treatment of autism, including Applied Behavioral Analysis (ABA), a substantially researched and favored behavioral treatment for autism spectrum disorders. This bill will require health insurance plans to include autism as a covered benefit.
Autism is extremely expensive to treat; the estimated lifetime cost of caring for a person with autism ranges from $3.5 to $5 million. However, if the appropriate early intervention treatments are applied, up to two-thirds of the cost for treatment can be avoided.“The passage of this bill is a triumph for the most vulnerable among us; those who we, as a society, have a responsibility to protect,” said Sen. Shaffer. “Autism is treatable, but these families should not face this alone. This bill will finally make healthcare manageable for those with autism disorders and their families.”
After the bill passed the Senate, Betty Lehman, Executive Director of the Autism Society of Colorado and a key architect of the bill, thanked individuals with autism in Colorado , their families and their providers, indicating their continued support ensured the bill’s passage. The Autism Society asked those affected by autism in Colorado to contact their legislators to encourage a yes vote on the bill, to great effect. Lehman also thanked the lawmakers that recognized the impact of the bill on Colorado families affected by autism.
“This bill will have a tremendous impact on the lives of people with autism and their families. It will also alleviate some of the financial burden on the public education, public health care programs, and social services systems in our state,” said Lehman.
Michael Zeitlin, Board President of the Autism Society of Colorado acknowledged the landmark bill would not have been possible without the hard work of the bill sponsors and Betty Lehman.
“Except for Senate Majority Leader Brandon Shaffer and State Representative Dianne Primavera, Betty Lehman was the single most important person involved in shepherding this bill through the entire legislative process, winning approval in both houses of the legislature and vetting about 50 amendments negotiated by various interest groups,” said Zeitlin.
The bill now awaits action by the Governor. If SB 244 is signed, Colorado will become only the 11th state requiring insurance providers to cover treatments for autism. The Autism Society of Colorado is excited to have worked diligently for legislation that improves the quality of life for people with autism and their families.
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Bridget Cessar
Communications Director
Autism Society of Colorado
Office: 720.214.0794, ext. 10
Fax: 720.274.2744
www.AutismColorado.org
