RSS NEWS FEED [CTRL-F to "search"]
PRNewswire, AUCD, UCP, The ARC, Autism Speaks
articles to display: 20 | 40 | 60 | all
Kaiser HeaIth News examines impact of federal directive to states to expand autism coverage
(August 26, 2014) -Kaiser Health News (KHN) has examined how the states are reacting tothe federal government's July directivetocover medically necessary treatments for autism for individuals under age 21. An estimatedone-third of all children with autismreceive primary coverage through Medicaid.
Theannouncementby the Centers for Medicare & MedicaidServices (CMS) makes clear thatautism treatment mustbe addressed under Early and Periodic Screening, Diagnostic and Treatment (EPSDT)serviceswhich cover Medicaid-eligible children up to the age of21. The states are now assessing how to implement the change.
While coverage ofapplied behavioral analysis"isn't explicitly required" by the new guidance, KHN noted,advocatesexpect it to be covered.
"Since ABA is the most accepted, effective treatment that isn't experimental and investigational, you can't just exclude it entirely," Daniel Unumb, executive director of Autism Speaks' Legal Resource Center told KHN.
In California, where the state has already begun steps to expand Medicaid coverage, an additional 6,000 children with autism could benefit under the new federal guidelines, said Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage.
“For them it's going to be a huge deal,” said Jacobson, who worked with Autism Speaks to help enact California's 2011 autism insurance reform law.
Unumb said over a dozen states had reached out to himforguidance on how to implement the new directive.Read more from Kaiser Health News.
At New Jersey event, Sen. Bob Menendez hails signing of $1.3 billion funding bill
PARAMUS, NJ (August 20, 2014) -- Sen. Bob Menendez (D-NJ), the lead Senate sponsor of the Autism CARES Act, celebrated the signing of the bill into law at an event here with representatives of Autism Speaks andNew Jerseydisabilities groups. The new law, which authorizes $1.3 billion in new federal research funding over five years, was signed earlier this month by President Obama.
"The Autism CARES Act not only provides for the continuation of vital federal efforts, but ensures they provide better outcomes,” said Menendez. (Pictured left with Valentine Center Executive Director Janet Mino and one of her students.)View event video below
“The law now ensures that we continue research into potential causes, new early diagnostic and intervention techniques, and more effective supports and services for those with autism and their families, and it pays attention to the unique needs facing those transitioning to adulthood and to independent lives.
“We have to be vigilant and united in our support—to put a focus on transitioning youth and adult services—so that children with autism are able to fulfill their God-given potential and become successful, independent adults,” he said.
Menendez spoke at the ECLC of New Jersey's Bergen P.R.I.D.E. Center, celebrating the new lawwith autism advocates.
"Senator Bob Menendez has been a reliable and effective champion for the nation's autism community, delivering once again with the enactment of the Autism CARES Act,” said Stuart Spielman, Autism Speaks' senior policy advisor and counsel.
“The unanimous Senate vote for the bill masks the hard work by Senator Menendez and our other Congressional champions in overcoming challenges that could have derailed continued federal funding for autism research," he added. "Autism CARES is a thoughtfully crafted piece of legislation that protects federal investment in autism for years to come while creating a role for the federal government in addressing the needs of our rapidly growing population of Americans with autism.”
Autism CARES reauthorized the landmark 2006 Combating Autism Act for through 2019 at an annual funding level of $260 million. The funding will be used primarily for autism research grants awarded by the National Institutes of Health. Autism CARES will also ensure the continued funding of autism prevalence monitoring; training of medical professionals to detect autism; and continued efforts to develop treatments for medical conditions associated with autism.
The federal government will be required under the new lawto inventorythe current state of adult services and report to Congress where gaps exist and how to most effectively address those needs. Autism CARES alsodirects the Interagency Autism Coordinating Committee (IACC) toavoid unnecessary duplication in research studies anddevelop annual updates to an autism strategic plan.The U.S. Department of Health and Human Services willbe responsible forimplementing the strategic plan and reporting to Congress on progress.
Successful litigation against insurers leads to state order
SALEM, OR (August 14, 2014) -- Acting in response to a string of successful lawsuits against the insurance industry, an Oregon state agency announced today that it would prepare a directive requiring all private health insurers to cover applied behavior analysis (ABA) for autism.
“Recent court decisions have brought clarity that coverage for ABA therapy should be required of all insurers,” said Insurance Commissioner Laura Cali. “After evaluating the latest ruling made in Oregon last week, we have determined there are limited circumstances in which denial of coverage for ABA therapy as a treatment for autism may be reasonable. We hope the bulletin will provide more certainty to Oregon families who seek this treatment.”
Cali was referring to last week's decision by U.S. District Court Judge Michael Simon striking down the use of a "developmental disability exclusion" by insurers to deny claims for ABA treatment for autism. The ruling came in a class action lawsuit brought by two families against Providence Health Plans.
Simon found that the disabilities exclusion violated federal and state mental health parity law.
In a previous case, McHenry v PacificSource Health Plans, the court struck down the insurer's claims that ABA was "experimental" and "educational," rather than medical, in nature. The health plan administered by theOregon Public Employees Benefits Board (PEBB)is currently beingsuedfor its refusal to cover ABA, while in neighboring Washington state a series of decisions in class action suits have run against insurers.
Last year, Gov. John Kitzhaber signed legislation requiring state-regulated health plans to cover ABA, but the requirement would not take effect until 2016.
The Oregon Insurance Division, which is part of the state Department of Consumer and Business Services,has the authority to issue bulletins to clarify requirements of insurance companies under the Oregon Insurance Code and other state and federal laws.
"This bulletin will explain that insurers cannot exclude coverage of ABA therapy for autism from their policies," the Insurance Division announced in a statement. "As with other types of medical services, insurers can make coverage decisions based on whether the therapy is deemed appropriate and medically necessary for an individual patient, but they cannot broadly deny payment for ABA therapy."
The statewill begin drafting the bulletin "immediately" and share the draft withconsumers, advocates, insurers, and other interested parties, for comment and feedback. The division also promised todevelop a "transparent and consistent approach" for resolving current and future consumer complaints and enforcing the bulletin.
The Insurance Division has drawn fire in the mediafor purportedly maintaining a cozy relationship withthe state's insurance industry.As reported by The Oregonian, adraft memo analyzing the 2013 autism insurance reform bill was shared with a lobbyist for Regence Blue Cross Blue Shield while the bill was still before the Legislature.
Cali took over as director shortly after the episode and told The Oregonian she was making improved autism insurance coverage a priority for the Insurance Division.
In Oregon class action suit, judge rejects 'developmental disability exclusion' widely used to deny claims
PORTLAND, OR (August 13, 2014) -- A "developmental disabilityexclusion" widely used by insurers to deny claims for applied behavior analysis (ABA) therapy for autism has been rejected in Oregon by a federal judge as a violation of federal and state mental health parity law.
Ruling in a class action lawsuit brought against Oregon's Providence Health Plan, U.S. District Court Judge Michael Simon ruled that "an insurer cannot provide coverage for a service for one child and deny coverage for the same service for another child solely because the second child suffers from a developmental disability."
The complaint, A.F. and A.P. v Providence Health Plan,was brought by two families raising children with autism and was certified as aclass action covering all Providence policyholders earlier this year.
Simon ruled that the blanket exclusionviolated the federal 2008 Wellstone Domenici Mental Health Parity and Addiction Equity Act, Oregon's Mental Health Parity Act and a 2007 Oregon statute regarding medical coverage for autism. According to the decision, "Providence cannot simultaneously purport to cover autism and yet deny coverage for medically necessary ABA therapy through its Developmental Disability Exclusion consistent with the Oregon Mental Health Parity Act."
Simon also made clear he considers ABA to be medical treatment, as opposed to a service provided by schools.
"The case is significant in holding that developmental disabilities exclusions are prohibited as'separate treatment limitations' applicable only with respect to mental health benefits," said Dan Unumb, executive director of the Autism Speaks Legal Resource Center. "The case is also useful in its discussion of othertreatment limitations, such as 'experimental' exclusions and 'medical necessity' exclusions that are often more restrictivelyapplied to exclude ABA coverage for autism.
"Finally, it is important just for making clear that coverage of ABA treatment for autism is a benefit with respect to a service for a mental health condition covered under mental health parity," he said. "Even if autism or related treatment may also be characterized as “developmental,”this does not in any way remove thiscondition from the protections of the mental health parity act."
In the course of the litigation, questions arose over the enforcement practices of the Oregon Insurance Division. External review boards over the course of several years ordered private insurers more than 20 times to cover autism treatment, but the state agency failed to enforce compliance, as reported by Willamette Week.
The report cited efforts by Paul Terdal, an Autism Speaks volunteer advocate, to improve the state's enforcement efforts.
WASHINGTON, DC (August 8, 2014) – President Obama signed the Autism CARES Act today, which dedicates $1.3 billion in federal funding for autism over the next five years. Autism CARES—introduced by Sens. Menendez (D-NJ) and Enzi (R-WY) and Reps. Chris Smith (R-NJ) and Mike Doyle(D-PA)—enjoyed broad bipartisan support in both the Senate and the House.
“Autism Speaks commends President Obama and our Congressional leaders for taking action on behalf of the millions of families affected by autism, which continues to rise at an alarming rate,” said Autism Speaks President Liz Feld. “These families are our champions and this critical legislation would not have been possible without the voices of tens of thousands of grassroots advocates from across the country.”
Autism CARES reauthorizes the landmark 2006 Combating Autism Act for another five years at an annual funding level of $260 million. The funding will be used primarily for autism research grants awarded by the National Institutes of Health. Autism CARES will also ensure the continued funding of autism prevalence monitoring; training of medical professionals to detect autism; and continued efforts to develop treatments for medical conditions associated with autism.
“Since 2006, the prevalence of autism has risen at an alarming rate to 1 in 68, including 1 in 42 boys. Given this epidemic, there has never been a greater need for these types of bipartisan efforts to make autism a federal priority,” said Feld. “We applaud Senators Bob Menendez (D-NJ) and Michael Enzi (R-WY) and Reps. Chris Smith (R-NJ) and Mike Doyle (D-PA) for their continued leadership and commitment to autism families.”
Autism CARES also tasks the federal government with surveying the current landscape of adult services and reporting to Congress where gaps exist and how to most effectively address those needs.
“There is a particularly acute need to serve young people with autism as they transition to adulthood and need new housing, employment, transportation, and other services," Feld added. “Autism CARES will be critical to identifying these challenges and the ways that the federal and state officials can address them.”
The bill also empowers the Interagency Autism Coordinating Committee (IACC) with the task of avoiding unnecessary duplication and making recommendations to implement a strategic plan. The U.S. Department of Health and Human Services is required to take charge of implementing the plan and reporting to Congress on progress.