Feds Clarify Autism Coverage Rules

In what advocates are calling a major win, federal officials are for the first time telling states that Medicaid coverage must include treatments like applied behavior analysis for children with autism.

Medicaid programs nationwide must offer “medically necessary diagnostic and treatment services” to kids with autism, the Centers for Medicare and Medicaid Services told states in abulletin this month. That includes everything from speech and occupational therapy to personal care services and medical equipment, the agency said.

Florida Seeks to Overturn Autism Ruling

MIAMI, Fla. -- Already facing sharp criticism over policies that have resulted in the rationing of care to severely disabled children, Florida healthcare regulators are challenging a federal judge's order that the state provide a costly -- but potentially life-changing -- treatment to children with autism.
Last spring, U.S. District Judge Joan Lenard struck down the state's refusal to pay for applied behavior analysis (ABA) for autistic children, calling the state's policy "arbitrary, capricious and unreasonable."

Read more here: http://www.bradenton.com/2013/01/06/4341212/faced-with-a-judges-order-that.html#storylink=cpy

Study: Large Percentage of Hispanic Children with Autism Remain Undiagnosed

Maribel Hernandez is a mother of two young sons with autism, Max, 12, and Chris, 10, and she agrees with the importance of early intervention.
“Sometimes, as parents, we want to justify the behavior of our children, but we have to admit the behavior is not right,” she says. “For example, when I noticed my son stopped talking, I justified it saying that he was just looking for attention.”
UC Davis MIND Institute released this week the largest study to date comparing the development of Hispanic and non-Hispanic children and found a higher percentage of Hispanic children often have undiagnosed developmental delays, or autism.

New Virginia Autism Law Faces Delay

NORFOLK, Va. -- Families of children with autism celebrated the passage of a law earlier this year that would require insurance to cover a costly treatment for the developmental disorder.
But advocates who worked more than a decade for the law, which goes into effect Jan. 1, 2012, were disappointed to find out that an amendment made by the governor could delay a key piece as long as two years.
One of the governor's amendments requires therapists of Applied Behavioral Analysis -- the gold standard treatment for autism -- to be licensed by the state of Virginia.
The regulatory process to set up a new license in Virginia takes 18 months to two years to complete, according to Karin Addison, a special adviser in the state's office of Health and Human Services. She said the law does not contain a fast-tracking clause, which could have sped up the process.

Popular Autism Therapy Closer to Insurance Coverage

SEATTLE -- Two recent events come as good news for parents of children with autism — some of whom have struggled to pay for an expensive therapy not now covered by state-funded insurance plans.

In a case involving three children with autism-spectrum disorders, a judge has ruled that state coverage plans can't impose a blanket exclusion on the therapy, Applied Behavioral Analysis (ABA).

And a state panel has voted to cover — with qualifications — the two most promising types of ABA therapy. The panel decides what treatments the state should cover for state employees, injured workers and people on Medicaid

Judge: Minnesota Autism Care 'Inconsistent'

ST. PAUL, Minn. -- A Ramsey County judge has ruled that Minnesota's Medicaid program has been "inconsistent" in paying for intensive autism treatment for some children while denying it to others.
But the ruling stops short of ordering the state to cover the treatment for a low-income child, identified as T.O., who is at the heart of the case.
The judge sent the issue back to an administrative law judge for further proceedings.
Amy Dawson, the lawyer representing T.O., had sued the state and HealthPartners for refusing to cover the child's bills for Applied Behavior Analysis (ABA) therapy. Dawson argued the state routinely paid those bills for more affluent families under a Medicaid program for disabled children, but refused it to low-income children like T.O., who was enrolled in a Medicaid managed-care program.

Autism's $100,000 Question

It all started with a scientist and 19 autistic children.
Ole Ivar Lovaas, a psychologist at the University of California, wanted to see if he could change the way the children behaved, given enough time and effort. So he lavished them with intensive therapy for 40 hours a week for two years or more.
At the end of the experiment, Lovaas reported that nine children -- 47 percent -- had no visible sign of autism by first grade.
Today, almost 25 years later, therapists in Minnesota are charging up to $100,000 per year for the treatment Lovaas pioneered, and some parents believe it is the answer to their prayers. Now a battle is raging in Minnesota about whether taxpayers and health insurers should be forced to pay for the treatment, known as Applied Behavior Analysis (ABA).

Applied Behavior Analysis: Educational or Medical?

Thought I'd share an interesting blog item from Lisa Jo Rudy on About.com about applied behavior analysis. With states across the country trying to ensure that such treatments are covered by medical insurance, thought this was a rather timely item. (Lisa and I also realized earlier this year that we attended the same day camp as children - small world!)