Governor Brown approves Autism bill

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PaintingDiva
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10 Oct 2011, 9:06 am

In case you missed it, Governor Brown of California signed a bill that will force health insurance companies to pay for a previously not payable therapy, see quote below from the S.F. Chronicle:

Quote:
The governor signaled reluctance in signing the autism bill, SB946 by state Senate President Pro Tem Darrell Steinberg, D-Sacramento. It mandates that health plans cover applied behavioral analysis therapy for children with autism, beginning in July 2012 and continuing for two years.

As a result, the mandate will either be temporary or act as a bridge to 2014, when the federal government is set to issue minimum coverage standards as part of the health care overhaul.

"While this bill provides relief for families of autistic children and some clarity for health plans, insurers and providers, there are remaining questions about effectiveness, duration, and the cost of the covered treatment that must be sorted out," the governor wrote in a signing statement.

The mandate does not apply to the state's Medi-Cal program, and Steinberg said that was because of the potential cost to the state's budget.
'Critical victory'

"This is a critical victory for thousands of California children and families. For many of them, having this therapy covered by their insurance is the difference between despair and hope," Steinberg said in a statement.

The state Department of Managed Health Care had, earlier in the year, entered into settlements with major health care providers that ostensibly addressed the issue, but advocates and parents of autistic children labeled it a "sham" agreement.

Bob Wright, co-founder of Autism Speaks, a national advocacy organization, hailed both Steinberg and Brown.

"Courage and common sense have prevailed as Gov. Brown has chosen to side with California families and taxpayers, rather than the health insurance lobby," Wright said.

Insurance companies argued that applied behavioral analysis, which has been called the most effective treatment for autism, is not a medical treatment. Autism diagnoses have been growing rapidly, and about 1 in 110 children has an autism spectrum disorder, according to the Centers for Disease Control and Prevention.

Health insurers were unhappy with the governor's decision, which they estimated would add $850 million in costs to the state's health care system.

"Shifting that nonmedical cost burden onto private insurers won't make the cost go away, it will simply make insurance harder to get and less affordable and accessible for millions of Californians," said Patrick Johnson, president of the California Association of Health Plans. "Nor will it have a benefit to the many low-income and disadvantaged children covered under public health plans, as they were exempted from coverage in this legislation."

The behavioral treatments are designed for each child and often take months of fortification. Therapists seek to reinforce behavior by focusing on environmental surroundings that impact a certain behavior, in a process that has been described as rewiring the brain.



sfgate.com



jstriding
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10 Oct 2011, 9:08 am

Thank you PaintingDiva! This is good news for those of us in California.



Bombaloo
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10 Oct 2011, 9:23 am

And hopefully good news for the rest of us eventually too. California has been the forefront of a lot of legislation that other states follow.



DW_a_mom
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10 Oct 2011, 9:59 am

From a public policy standpoint, the hope is that the treatment will eventually pay for itself in reduced needs for services when the kids have become adults.

As a parent, that is also the result we seek: kids that will ve able to function in the world to at least some degree.

I guess that is the data that doesn't yet exist, because I thought it was known that this is the most effective therapy out there for very young, more severely affected kids.

--

I actually have mixed feelings about things like this. It is a change I know needs to happen, and insurance is the best place for it, but we're also in a world where society cannot afford to pay for everything people think it is supposed to pay for, and we are going to have to come up with some common sense ways to draw that line in. So while this bill is an important victory for the families that needed and could not afford this therapy, we do have to ask, "at what cost?" It is only a temporary bill, so hopefully the questions will have a clearer answer in two years time.

As for insurance company claims that it isn't a medical treatment .... interesting. Those lines get so blurred, and the problem is that it can lead to dumb decisions. With my hearing loss I had the option of an expensive surgery - which insurance would have covered, or hearing aids - which costs much less but insurance does not cover to any reasonable extent. I have always found it absolutely ridiculous that insurance companies are practically forcing people to take the costlier - and riskier - option (I didn't, I went the way I wanted to, cost and coverage decisions be dammed - but I tend to be like that ;) ). So what happens with kids that could have benefited from ABA but never got it? Most of them end up medicated, and the insurance companies are going to pay for that for their entire lives. Nuts, isn't it? I would really like to see long term cost benefit studies.

Sorry for thinking out loud. Please don't pick apart these random thoughts! They are just that ... unresolved random thoughts.


_________________
Mom to an amazing young adult AS son, plus an also amazing non-AS daughter. Most likely part of the "Broader Autism Phenotype" (some traits).


Last edited by DW_a_mom on 10 Oct 2011, 11:05 am, edited 3 times in total.

claudia
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10 Oct 2011, 10:04 am

Thank you Gov. Brown!
I hope this can become an example for other countries.



jstriding
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10 Oct 2011, 3:36 pm

DW a mom thank you for sharing your thoughts -- I share similar struggles and mixed emotions. As a preface: we won't benefit from this bill yet, since we don't have a diagnosis (right now my 4 year old son has a diagnosed speech & language delay and is in a special ed preschool program)

On the one hand, I'm grateful for for provisions of IDEA 2004 that requires every child including children with disabilities to receive the appropriate public education, for free. I deeply believe that this is a true investment in our children's future -- for both special needs children (so they don't become burdens to society) and typical children (so they don't end up bearing the burdens of their special needs peers). It makes total sense.

My conflict comes from healthcare coverage of ABA therapy. I remember reading how schools say this is a medical condition, it's not fair for them to pay the cost of a medical treatment. Then insurance companies say this is an educational issue, it's not fair for them to pay the cost of an education-based intervention. I used to work in healthcare, not education, so my opinion can only be based on the healthcare side. I say this is more a medical issue than an educational intervention. But I also know the head honchos who work in insurance companies are all about optimizing costs so that they can afford to pay for members who use resources (such as chronic diseases, cancer patients, diabetes, heart patients). Maybe one approach is a shared burden based on ability of members to pay, based on incomes.



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12 Oct 2011, 1:59 pm

I'm not trying to be ms. negativity here, but I don't think there's much to be excited about here - not yet anyway. The article does say that The Medi-Cal program is exempt. I'm not terribly familiar with CA insurance, but isn't that similar to a chip plan for kids? If so, then families struggling financially, enough to qualify for Medi-Cal, wouldn't even see any benefit. So basically, those who are more likely to be able to afford therapy anyway, now are able to get it covered. Meh, not a huge victory.

Also, I think other exemptions apply such as grandfathered plans (or something like that). In PA, where I live, we also have a "mandate" for autism treatment, but it's a joke. Very few insurance companies actually fall into this mandate, including my own :( .

When I lived in NY, our insurance wouldn't cover anything autism related - not even a diagnosis. So I was a bit excited to be moving to a state that was supposedly so supportive in this area. It's been a huge disappointment. If the school doesn't cover it, we can't afford it. Thankfully, my son's been doing great on his own so we've been fortunate. But I often think about families with more serious issues and how they are left to fend for themselves.