"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. (...)
"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.
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."
“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".
Oregonian - Letters to the editor: Autism Funding May 2, 2009
Cover autism therapy
How nice for State Rep. Mitch Greenlick that he only has to ponder whether or not behavior therapy would help all children with autism, all the time, with all its symptoms ("A struggle to defeat autism and its costs," April 29).
Is there a single medical protocol with a 100 percent success rate for all afflicted?
I have a child with autism, so I can tell you that behavioral therapy works wonders. It is a remarkable tool that changes kids' and families' lives. It isn't invasive, it requires no expensive equipment and the skills can be taught and used at home and in school.
Can you imagine being told that your child's needed speech, occupational, physical and behavioral therapies are not covered by insurance? Note that these same policies cover addicts, the obese and smokers.
Oregon's autism rate is among the highest in the nation. Funding treatment that helps children with autism become productive, able, self-directed citizens is a vital investment. Please ask your legislators to add Oregon to the list of nine other states that have already passed this critical insurance reform.
DANNI McLAUGHLIN
Southwest Portland
"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.'"
Presentation by Lorri Unumb, Esq., Senior Policy Analyst, Autism Speaks, in public testimony to the Oregon House Health Care Committee, April 8, 2009.
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
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
"...(ABA) is considered by many to be the "gold standard" in therapy and treatment for children and other disorders, but specifically for autism...[on whether autism should be addressed by schools or medicine] right now autism is diagnosed by physicians, not teachers, so that really puts the onus on the medical community, and therefore, the insurance companies to cover it. I think we're starting to see now people thinking not just with their bankbooks here, but with their hearts, soul--they need to invest in the future of these children, or the costs will be much higher."
