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Up to 80 percent of autistic children could hold jobs and become independent, according to Sandra Hastings, a certified behavioral analyst, who has worked with autistic children since 1989 and is now working in the Santa Rosa County schools in Florida. Hastings is quoted in an article in the Northwest Florida Daily News about the costs of autism and specifically for intensive therapy using Applied Behavior Analysis. A new piece of legislation in Florida, “The Window of Opportunity Act,” would
require large group health insurance plans to provide diagnostic screening, intervention and treatment of autism. It would prohibit insurance companies from denying autistic children therapy.
Two separate bills, SB 2654 and HB 1291, are working their way through House and Senate committees. The Autism Society of America-Broward Chapter has more details about the act, which also calls for “public institutions of higher education to incorporate into educator certificate course curricula recommendations of Commissioner of Education relating to autism awareness & teaching students who have autism spectrum disorder.” (And here’s some recent discussions about legislation that passed in Arizona providing for insurance coverage for ABA; about a bill in Wisconsin that did not pass; and about a family in Colorado who successfully sued their insurance company to get coverage for ABA.)
David Triana of Navarre, who notes that he pays $13,000 per year for his 13-year-old son’s ABA, says “‘“Early identification, early intervention provide for you to take advantage of the window of opportunity to give children the intensive therapy to reach their maximum potential.’” The need to hurry hurry and do as much as early as possible is an argument frequently used to explain why intensive treatments are necessary for young autistic children. Early intervention was important to get my son’s learning started but—as he’s gotten older–I’ve learned that the windows don’t “shut,” but that they get bigger—-and they stay open.
@ Maureen
If that is true–that the legislation passed in other states for autism basically “stands alone” thereby creating a distinct class or group (autistics), apart from the other classes or groups with similarly situated developmental conditions (like DS), then there lies the problem with the bill. We cannot differentiate based on a classification or specific diagnosis when the “degree of need” for treatment is the basically the same for both groups.
-tslupelli77@yahoo.com
@Shawn
1. These insurance bills are the first time that ABA is being covered for any condition, therefore in answer to your question this is not to add autism but rather to cover ABA for autism.
2. It is also very important to note that most states do not mandate coverage of OT, PT, or SLP for any conditions–even physical conditions that necessitate these services to increase or maintain ROM (range of motion), further many plans specifically exclude OT, PT, SLP for just that kind of coverage, therefore they only cover a set number 10-25 units per year in response to an acute incident (an accident/injury). Some states had begun requiring that insurance companies cover a set dollar amount ($5-10,000) for therapy during the birth to three age range (NH, MA and I believe VA) regardless of diagnosis. But most only state that if the policy covers OT, PT, SLP that early intervention could bill for reimbursement, but since most policies are written to address adults who have had an insult or injury the bills for early intervention services are routinely denied.
What we need is for all children with chronic health conditions and/or disabilities to have a portion of their therapy services covered by insurance–thus we have a three-legged chair: Family (premiums, co-pays, deductibles and additional), Government (early intervention, school-based, Medicaid, DDD…) and insurance. Unfortunately, children with autism are not the only children with disabilities who are not receiving assistance from the third leg.
I’m very interested as well–to compare and contrast the bills from other states. What I really want to know…Are these other conditions like DS, SB, CP, etc. already covered for ABA therapy in places like NJ–and now they are just trying to add autism to the list of already pre-approved conditions that qualify for the insurance-covered treatment?
@Shawn Lupella, Esq., Thank you—I’d like much to know what you find out and how your efforts proceed. Here in New Jersey there’s a bill before the assembly for insurance coverage of autism treatments and it helps a lot to know what other states have done. Very best—
Maureen, Kristina Chew PHD. Especially good points. The bill that passed is flawed and maybe unconstitutional. Autism should not have been the only group covered. Down Syndrome, Cerebral Palsy, Spina Bifida, etc. should have been part of this bill. I have already started working to try to figure out how to include these other groups. As an attorney and a father of a son with down syndrome, I feel called to the task. If anyone agrees-and wants to join in…let me know. If the legislature won’t take it up in the next session, I am prepared to litigate to make it happen.
@Ana,
We never received any coverage for behavioral therapy either. Music therapy—lessons—have really helped my son; definitely not covered by anyone. And, when our son was 7, we had to withdraw him from his public school classroom because things were not working out and we were concerned about his safety. Is he being homeschooled now—-and how is that working out? Very best—
Our son, a severely autistic 8-year-old, has never received coverage for behavioral therapy. Like other kids living with this horrendous disability, he would have also greatly benefited from music therapy and the neurofeedback (which are not covered by health insurances). In addition, we were recently pressured by his public school to withdraw him; which we did concerned about his overall safety. We enrolled him in home schooling, which we were told could be funded by the McKay Scholarship. However, this is very false. Neither they want him in school nor can we afford the high costs of educating him at home or of the therapies that are medically neccessary for him. It is very agonizing. There is just no compassion or willingness to help children like our son overcome this tragic disability.
If would be fair for health insurances to cover behavioral and music therapies and the neurofeedback. I have seen proof that these medical interventions are much more helpful to children with severe autism than others currently covered by insurances in Florida.
Excellent that it passed in the Senate. Hopefully it will go as smoothly in the House and the other bill will get out of committee.
From Florida.gov wesite
S2654 Steven Geller Autism Coverage Act”
passed Senate 4/23/08
yeas 30, Nays 0, Not voting 1
Now goes to FL House
HB1291 Still in Healthcare council committee
State Senate Bill 2654 — Autism Spectrum Disorder — has passed the appropriate committees and seems ready to be passed by the full Senate this year. The companion bill in the House, HB 1291, has 80 cosponsors. But because of Speaker Marco Rubio’s preference for the insurance industry, his biggest contributors, this bill has been waiting since April 2 to be scheduled before the Health Care Council.
Florida’s bill passed:
1485 days ago
[...] Florida [...]
Well, looks like both bills are still in play
S2654
04/08/08 SENATE Now in Health and Human Services Appropriations; On Committee
agenda– Health and Human Services Appropriations, 04/10/08,
2:30 pm, 110-S
H1291a
04/02/08 HOUSE Now in Healthcare Council -HJ 00404
@Dr. Hastings,
Thanks for noting the source of the “80%.” I’ve many hopes that my son can be in that percent.
Jonathon,
Don’t believe everything you read. What I said was that “IN MY EXPERIENCE” as the former manager of a Supported Employment program “UP TO 80% of the people” I served with autism were able to maintain some level of employment….that part doesn’t always make it into print. I am sorry you have had such a difficult time with employment. I certainly understand how hard it is to find and keep jobs. For the record, I don’t “conjure” anything from thin air or elsewhere. My hope for you – and for everyone who walks in your shoes – is to find the peace you need, whether that is through employment, relationships, education, or solitude.
Sandy
Messy and forging on—
@Maureen, you wrote “I truly believe that we have got to work together across disabilities”—I just have to say, yes and yes. I’ve been thinking about how many fewer research funds are allotted to (for instance) Down syndrome than for autism, presently. Of course there are differences but we also overlap.
Hello friends -
The crazy part is that the insurance bill will likely never even come up for a vote; the person chairing the committee in the Senate is against any mandate of any type of insurance. Unfortunately, all this does is mandate that the state pick up the tab; although with several thousand children on the waiting list, and a few hundred being picked up every year, most children will likely be teenagers by the time they are ‘accepted’.
As far as 80% goes, considering most ‘autism’ these days is ppd, that might not be too far off the mark. Messy system.
Sigh.
- pD
As someone concerned with disabilities on a larger scale I was one advocating for a more inclusive bill–that would have ensured access to behavioral intervention, OT, PT, and speech for all kids with disabilities. I truly believe that we have got to work together across disabilities. (I think it is reprehensible that insurers specifically exclude these services for children with chronic conditions or developmental disabilities–whether they have autism, down syndrome, Prader-Willi, Williams…).
However, as for the light speed. There was both grassroots support and lobbyist support. It seems that they chose to get incremental passage, and behavioral intervention was kept in the bill, while the other therapies did not remain in the final bill (which was a compromise between two very different approaches to the issue). Also it does seem that the $ figure helped the measure along as well–probably as previously mentioned– because it means a limit on an annual and lifetime basis.
“The advocates and the insurers negotiated the OT, PT and Speech out of the bill”
——————
Interesting. In Oregon ABA was negotiated out of the bill, so OT, PT and speech was what was left.
The passage in AZ was notable for getting the measure passed with almost breathtaking speed as measured in politics.
Maureen, if you were involved in the campaign, do you know what helped to get the measure through the legislature so successfully?
@Maureen,
thanks for noting that—–was this done to get the bills through? one step at a time….. My son’s received extensive ABA since he was ust over 2 years old, through the public schools in NJ and privately.
As far as these bills being about more than ABA:
Please note that the Arizona law is ONLY about behavioral intervention (ie ABA). The advocates and the insurers negotiated the OT, PT and Speech out of the bill and the dollar amounts are $50,000/year for under 9′s and $25,000/year for 9-18 year olds with an ASD.