VIDEO: Autism Not Treatable? Sam Summers, MI 4th Grader Disagrees.

This was from the testimony for the Michigan autism bill--Sam Summers, Michigan 4th grader diagnosed with autism at 2, given intensive behavioral intervention...well, let Sam speak for himself.

Sam Summers Testimony for Autism Insurance

Sidebar: Blue Cross Blue Shield of Michigan Forced to Pay for Behavioral Therapy for Autism In Landmark Case

Release issued by Mantese and Rossman, P.C., on June 19, 2009

Detroit, Michigan. The family of an autistic child filed a motion in federal court today to confirm settlement of a class action against Blue Cross Blue Shield of Michigan. The family alleged in the suit that the insurer wrongfully refused to cover behavioral therapy for children with autism spectrum disorder (ASD), on the baseless ground that the care was"experimental. "

Under the terms of the settlement reached at a court-ordered conference on Wednesday, June 17, 2009, Blue Cross [of Michigan] has agreed to reimburse all families who paid for behavioral therapy for their children after May 1, 2003, and who were covered under a Blue Cross Blue Shield of Michigan insurance policy. Blue Cross had earlier filed a motion seeking dismissal of virtually the entire case on legal grounds, but the Honorable Stephen J. Murphy III permitted the case to go forward and scheduled the matter for further proceedings, including a settlement conference before Magistrate Michael Hluchaniuk.

The settlement was reached in the case of Christopher Johns v. Blue Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the suit, the plaintiff alleged that Blue Cross' pattern and practice of characterizing the scientifically established Applied Behavioral Therapy as "experimental, " and thus as excluded under its insurance policies, was arbitrary, capricious, illegal and contradicted by many years of scientific validation.

Under the settlement, Blue Cross [of Michigan] will pay for behavioral therapy rendered to over 100 children in the last six years. Plaintiff's counsel, Gerard Mantese and John J. Conway, were pleased with the settlement.

Mr. Mantese and Mr. Conway issued a joint statement emphasizing:

"No insurer should ever take this approach to needed care for children. Applied Behavioral Analysis therapy is supported by science and is not 'experimental. ' Delays by insurers in authorizing this treatment, when it is covered by insurance policies, should not be tolerated. Research shows that children with autism spectrum disorder need this therapy early on in life and delaying treatment can irreversibly prevent them from achieving their full potential."

Mr. Mantese emphasized that the settlement includes even families who never submitted a claim to Blue Cross, but who obtained this care for their children and were covered by a Blue Cross policy. Mr. Conway believes that this is the first such settlement addressing Applied Behavioral Analysis (ABA) in the country.

ABA therapy is administered under the supervision of licensed psychologists and other professionals. ABA applies one hundred year old concepts of changing behavior through positive and negative reinforcements. The federal suit in which this settlement was achieved centered upon the ABA treatment provided by prestigious Beaumont Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori Warner.

The case settled shortly after Plaintiff's counsel obtained a court order requiring Blue Cross to produce file documents which validated the effectiveness of ABA therapy for treating children with autism spectrum disorder.

Among the documents in the Blue Cross files obtained by Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical Policy for 2005, which acknowledged the following:

Applied behavioral analysis (ABA) is currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by the American Academy of Pediatrics, National Academy of Sciences Committee and the Association for Science in Autism Treatment, among others.

Blue Cross' own documents further acknowledged that:

The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions.

Mr. Mantese stated,

"After we compelled Blue Cross through motion practice to produce all materials supporting its position that this care was allegedly experimental, we received numerous file documents which actually established that ABA therapy works and is highly effective in increasing the functioning of these children."

Mr. Conway emphasized, "We are pleased that we were able to obtain a result which will require Blue Cross to pay for this important care and will alleviate some of the financial strain imposed on over a hundred families by having to pay for this care when it was covered under their insurance policies."

Contact information for the families' attorneys follows:
Gerard Mantese, Esq.
Mantese and Rossman, P.C.
1361 E. Big Beaver Road
Troy, Michigan 48083
248-457-9200 Office
248-515-6419 Cell

John J. Conway, Esq.
John J. Conway, P.C.
645 Griswold St, Ste 3600
Detroit, MI 48226
313-961-6525 Office
313-574-2148 Cell

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Previous newsstories on the case:

Blue Cross Reverses Position on Autism After Federal Court Litigation Intensifies
Monday 11th of May 2009 13:19

Blue Cross ordered to defend stance on autism therapy coverage
Detroit News | March 9, 2009

Sidebar: "Educating Children with Autism Statewide Conference"

This came in the email today, and while not immediately concerned with HB 3000,[Requires health insurers and state medical assistance program to reimburse for diagnosis and treatment of autism spectrum disorder.] might be of interest to those who are interested in autism treatment and what the state of Oregon is proposing to do in educating our children.
Oregon House Representative Chris Edwards will be sharing legislative updates

Educating Children with Autism
Statewide Conference
Saturday, May 16, 2009

Portland Memorial Coliseum meeting rooms, Rose Quarter

www.ceed.pdx.edu/autismconf
(Breakfast and lunch are included in the conference fee of $45-55)

Please join us for an exciting day focused on the education of children with autism spectrum disorder. Highlights of the conference:

The keynote speaker, Dr. Laura Schreibman, professor at University of California at San Diego , will be speaking on “The Science and Fiction of Autism”.

Dr. Schreibman will also do a session on the latest research for Pivotal Response Training (PRT). Additionally there will be 20 breakout sessions on a variety of topics presented by specialists throughout Oregon .

Representative Chris Edwards will provide an update on the latest legislative agenda in the area of autism.

The conference will focus on current instructional strategies used in Pre-k through 12^th grade classrooms and will also provide practical field-tested suggestions. There will also be a strand on school, family and community partnerships.

The workshops are designed to be a resource for people who are new to the field of autism training as well as those with advanced knowledge and experience.

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Conference and registration information are available at:

www.ceed.pdx.edu/autismconf

(Breakfast and lunch are included in the conference fee of $45-55)

Venue: Portland Memorial Coliseum meeting rooms, Rose Quarter

Maps, directions and parking information available on the conference website

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Sponsored in part by:

Portland Trailblazers,, Oregon Department of Education Northwest Autism Foundation,

Easter Seals of Oregon, Portland State University

From the Oregonian on ABA and HB 3000

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.

"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...

"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

-------------------------------

1. 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
   
   
2. "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/
   
   
3. A ctuarial Cost Estimate: Connecticut Senate Bill 301 An Act Concerning Health Insurance Coverage for Autism Spectrum Disorders
   

   Oliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA
   From Autism Votes
   
   
4. 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
   
   
5. 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
   
   
6. 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
7. Presentation by Lorri Unumb, Esq., Senior Policy Analyst, Autism Speaks, in public testimony to the Oregon House Health Care Committee, April 8, 2009.
   

8. Lorri Unumb, Esq., Senior Policy Analyst, Autism Speaks. (Personal communication)
   
   
9. 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.
   
   
10. 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."
    
    
11. 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.
    
    
12. UCSD Autism Research Program, University of California, San Diego
    Accessed April 28, 2009.
    
    
13. 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
    
    
14. 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.
    ,
    

ABA and Neurodevelopmental Disorders - Scientific Support

Applied Behavior Analysis and Neurodevelopmental Disorders:
Overview and Summary of Scientific Support

Authors: Louis P. Hagopian & Eric W. Boelter
The Kennedy Krieger Institute and Johns Hopkins University School of Medicine

"Applied Behavior Analysis Defined.

Behavior analysis is the systematic study of variables that influence behavior (Sulzer-Azaroff & Mayer, 1991). Applied behavior analysis (ABA) is a discipline concerned with the application of behavioral science in real-world settings such as clinics or schools with the aim of addressing socially important issues such as behavior problems and learning (Baer, Wolf, & Risley, 1968). Procedures derived from the discipline of ABA have been implemented to assess and treat a broad range of behaviors with individuals diagnosed with intellectual and developmental disabilities. However, despite more than 40 years of applied behavior analytic research there continues to be misperceptions about ABA. One misperception is that ABA is a standardized treatment program that is used for a specific type of problem and with specific types of individuals. For example, some incorrectly believe that ABA is a type of therapy or a specific procedure for teaching children with autism, and that it is synonymous with “Lovaas Therapy” or “discrete trial training.” Although discrete trial training represents one type of ABA-based approach, the field of ABA is much broader and includes a range of tactics, methods, and procedures that have been shown to be effective for many different types of problems. Features common to all ABA-based approaches are the objective measurement of behavior, precise control of the environment, and use of procedures based on scientifically established principles of behavior. Any clinical procedure or research investigation adhering to these basic criteria can be considered to be an ABA-based procedure. This includes “functional behavioral assessment,” and approaches such as “Positive Behavioral Support,” and forms of “Behavior Therapy” that rely on direct observation of behavior and analysis of behavior-environment relations..."

FULL ARTICLE

• Applied Behavior Analysis Defined
• Scientific Support for Applied Behavior Analysis
• Application of ABA-based procedures across settings and populations
• Scientific, Professional, and Government Organizations’ Position on Applied Behavior Analysis.
• Empirically Supported Treatments for Problems Associated with Mental Retardation, Autism and Related Disorders.
• Legislative Rulings in Support of Funding and Access to ABA-Based Services.
• Link to list of references

How ABA/EIBI Can Change Autism Trajectory

"...Early intensive intervention offers considerable benefit.

This concept became clear in the 1980s and has wide support today,[3],[4],[5] based on the success of early training compared with treatment that starts after children begin school...there is evidence that every year intervention is delayed progressively reduces outcome,...Brain plasticity refers to this ability of the brain to change under genetic and environmental forces, and this plasticity is at the heart of why earlier intervention works so much better than later intervention...So what does this have to do with autism? Plasticity explains why autism...can be helped by intervention in the form of intensive teaching, and why the younger the intervention is started, the better it works...The concept that early intervention is about brain plasticity is growing. [3],[8]..."

ARTICLE
Special Commentary: How Can Early, Intensive Training Help a Genetic Disorder?
William A. Altemeier, MD; and Leah E. Altemeier, PhD
Pediatric Annals 38(4), 167-172. March 2008,

SELECTED REFERENCES
3. Dawson G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20(3), 775-804.
doi:10.1017/S0954579408000370

4. Lovaas I.O. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

5. Johnson CP, Meyers SM (2007). Council on Children with disabilities. Identification and evaluation of children with autism spectrum disorder. Pediatrics, 120(5), 1183-1215.
doi:10.1542/peds.2007-2361

8. Oberman L. M., & Pascual-Leone, A. (2008). Cortical plasticity: A proposed mechanism by which genomic factors lead to the behavioral and neurological phenotype of autism spectrum and psychotic-spectrum disorders. Behavioral and Brain Science, 31(3), 276-277.
doi:10.1017/S0140525X08004378