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Senate President Steinberg suggests possibility of funding Medi-Cal coverage
SACRAMENTO (March 5, 2014) --The leader of the California Senate has raised the possibility of funding coverage for applied behavior analysis (ABA) for autism through Medi-Cal, the state's Medicaid program.
Senate President pro Tem Darrell Steinberg raised theMedicaid funding issue at the conclusion of a hearingby the Senate Select Committee on Autism & Related Disorders on the effectiveness of SB.946, the state's 2011 autism insurance reform law.Steinberg, who authored the law, said the law on balance has been a "tremendous success."
"The next step, of course, is extending (applied behavior analysis) therapy to families who are on Medi-Cal," Steinberg said, according to California Healthline. "It's equal protection. If it's good for some kids, then why isn't it good for all kids?
"It's an issue of money, and we intend to take that up during the budget session," Steinberg said. "We ain't done yet. There's one more budget cycle."
Last year, the Legislature and Governor Jerry Brown failedto reach a funding agreement to continue autism therapies for 900,000 children who transitioned out of the Healthy Families Programinto Medi-Cal. The transition was supposed to have resulted in no loss of services, but instead many families said their children lost access to ABA once in Medi-Cal.
KXTV-10,Sacramento's ABA affiliate station, reported on the hearing:
Jon Owen with Utah Autism Coalition makes case for SB.57
SALT LAKE CITY (March3, 2014) -- The Salt Lake Tribune conducted a live webchat on two autism insurance bills before the Legislature featuring reporter Kirsten Stewart, Jon Owen, president of the Utah Autism Coalition, Rep. Ronda Menlove and Kelly Atkinson, executive director of the Utah Health Insurance Association.
Menlove is sponsoring HB.88, which would makea pilot state program that serves 300 children with autism permanent. Menlove has said the program would address about 10 percent of the state's need.
Owen said his group supports SB.57, sponsored by Sen. Brian Shiozawa, which would require state-regulated health insurers to cover medically necessary treatments for autism, including applied behavior analysis (ABA). Owen said the bill, which passed the Senate last week, would complement Menlove's initiative by enabling families with insurance to use those benefits rather than join in the competition for benefitsprovided through the pilot program.
State with highest autism prevalence in the nation moves step closer to requiring treatments
SALT LAKE CITY (February 28, 2014) -- The Utah Senate has approved SB.57,thefurthest an autism insurance reform bill has progressed in the state Legislature since efforts began in 2009. Utah has the highest prevalence of autism in the nation at 1 in 47, yet is one of of only 16 states not to require private insurers to cover medically necessary treatments.
The vote was 18-7.
"Autism Speaks commends Senator Brian Shiozawa [left] for his leadership in steering this urgently needed legislation through the Utah Senate," said Mike Wasmer, Autism Speaks' associate director of state government affairs. "We join with the Utah Autism Coalition and the state's autism community in urging the House to now do what's right and pass this bill."
Shiozawa's bill would require state-regulated health plansto coverspeech, occupational and physical therapy, psychological and psychiatric care, and behavioral health treatments, including applied behavior analysis (ABA).Behavioral health treatment benefits would be capped annually at $36,000 throughage 9 and $18,000 from ages 9 through 18.
During debate on the bill Thursday, Shiozawa said autism is "in epidemic proportions, the insurance companies themselves say that autism is in epidemic proportions in the state of Utah. They acknowledge that this is a real condition, they also acknowledge that there is a best therapy for this.
"We're asking that they simply cover this condition," Shiozawa said.By supporting the bill, Shiozawa told his colleagues, "You give the children and their families, the thousands of children in the state of Utah a voice, a voice to be heard by the insurance companies, a voice that says to them we faithfully pay our premiums, please cover our condition."
Shiozawa said he had attempted to craft a workable bill by working with two major Utah insurers.
"I have gone to their offices, I have sat down with them, I have offered that we will do whatever we need to do to negotiate on this, on dates of services, on the ages, on the caps," he said. "Make this your bill, this is your opportunity. And their response is, no, we're going to fight this and we're not going to pay for this."
Senator Scott Jenkins of Plain City spoke against the bill, calling it a form of socializing costs. "This is making it a mandate for the insurance companies to cover their insured," he complained.
However, Senator Todd Weiler from Woods Cross said the autism debate had changed his views on insurance after a constituent explained how his son with autism was initially denied coverage for a broken arm.
"The insurance company denied the bill using as an excuse the child had been diagnosed with autism and that the broken arm most likely was caused because the child was autistic," Weiler said."That is discrimination. And if that's how insurance companies are going to treat children in my district, that's going to change my opinion about insurance mandates."
Senator Deidre Henderson of Spanish Fork said the insurance lobby had indicated that the billing was later resolved after an investigation determined the original denial was the result of a "miscode." She voted against the legislation.
Senator Karen Mayne, a retired para-educator from West Valley City, said when she began her career, no more than one or two children in the school had autism."When I left we had just about one in every class...This is an epidemic, this is divorce city, this is crisis city and there is only so much energy in a family and it does more than harm the child, it harms the family, it harmssociety."
Agency shows progress made under Combating Autism Act
WASHINGTON, DC (February 28, 2014) -- The U.S. Department of Health and Human Services (HHS) has reported to Congress on how funding dedicated to autism research and services under the Combating Autism Act (CAA) has been allocated and theprogress that has been achieved under the law.
"Since the enactment of the Combating Autism Act in 2006, and its reauthorization under the Combating Autism Reauthorization Act of 2011, federal agencies, in partnership with the community, have made significant strides in addressing many of the pressing needs of individuals and families affected by autism spectrum disorder,"HHS reported.
The 2011 law dedicated $231 million a year in federal funding for autism research and services through September of this year to HHS, allocated primarily to the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration.
"Autism Speaks is actively working with our champions in Congress to reauthorize the CAA before September 30, and we will again demand this accountability over how federal dollars are spent on autism activities," said Liz Feld, president of Autism Speaks. "Progress has been gained in our understanding and treatment of autism, but much more needs to be done. The law should continue to provide structure and transparency for the most efficient and effective use of federal dollars.
"Autism Speaks has provided nearly $200 million for autism research and is funding breakthrough science that can make a difference for our community," she said, "but autism is an issue that covers the lifespan and we need a national strategy now to meet the employment, housing and community integration needs of all those affected.
"But we can't do this alone. We need a strong federal partner to address what is a national epidemic."
Among the advances cited by HHS between 2010 and 2013 were:
- the new prevalence estimate of 1 in 88 children, along with a finding that more children are being diagnosed by age 3, creating critical opportunities forearly intervention
- expanded outreach to underserved populations to access diagnoses
- new findings on risk factors, including environmental risk factors such as nutrients, air pollutants, pesticides, and paternal age
- studies of conditions that often co-occur with ASD, such as gastrointestinal disorders, sleep disruptions, and epilepsy, are contributing to intervention strategies
- efforts to develop and evaluate educational interventions, as well as provide guidance for schools on how to make school environments safe and conducive to learning for students with disabilities
"While the collaborative efforts of federal and state agencies and community partners have resulted in many research advances and improvements in services over the pastseven years, all acknowledge the growing needs of the community and the work that remains to be done,"HHS concluded. "Continued collaborative efforts between the public and private sectors will be essential to drive the innovations that will lead to improved identification, interventions, services, and policies that will enhance the lives of people with ASD and their families."
Measure would provide coverage through age 6
ATLANTA (February 25, 2014) -- The Georgia Senatevoted unanimously fora compromise autism insurance bill after hearing several lawmakers, some in tears and onequoting fromthe Gettysburg Address, argue for passage of the bill. It goes now to the House of Representatives.
Sponsored by Senator Tim Golden of Valdosta, the chair of the Senate Insurance Committee, the bill, SB.397, would require state-regulated health plans to cover the screening, diagnosis and treatment of autism through age six. Coverage of applied behavior analysis (ABA) treatment would be covered up to $35,000 a year.
"This is a finely crafted bill," said Golden. "If it is to have any chance at all (in the House), it needs to come out of the Senate with no changes."
Several speakers credited Lt. Gov. Casey Cagle for breaking an impasse in the Senate by helping to broker the new bill. Cagle spoke for the bill before the Insurance Committee last week, the first time he has ever appeared beforea legislative committee.
The Senate voted 51-0 for the bill, whichisa newcompromise version ofAva's Law. Sen. John Albers, the sponsor of the original Ava's Law bill, spoke in favor of the compromise version.
"This is a great day for Georgia," said Albers. "This helps children,it helps people with specialneeds and it saves the state money, allat the same time. If you every voted for a bill like that, I would like to know what it is."
Ava's Law was named after Ava Bullard of Lyons, whose mother Anna has helped rally advocates around the state for better insurance. Her uncle, Senator Tommie Williams, spoke passionately for the bill on the Senate floor and took on the National Federation of Independent Business, a lobbying arm for small businesses.
"I own five businesses and I've started other businesses that failed," Williams said. "When I buy something I'm not just interested in the lowest price, I'm interested in quality at the best price.
"That's what they (NFIB) should be doing for me as a small businessman, and not just saying every mandate is bad."
Bill moves to Senate with no caps on age, visits, or dollars
PIERRE, SD (February 24, 2014) -- The South Dakota House of Representatives yesterday approved an autism insurance reform bill 57-12 and sent the measure to the Senate. As amended by a House committeee, the bill, HB.1257,sets no dollar or visit caps on treatments, or age limits forreceiving treatment, which includes applied behavior analysis (ABA).
Rep. Scott Munsterman, the chair of the House Health and Human Services Committee, said the bill would apply to health plans covering 60,000 to 90,000 South Dakotans. In response to criticisms the legislation would not cover more indviduals, he said it could be amended in the Senate to be broader.
Much of the floor debate on the bill involvedcriticisms of the insurance industry. In response to an industry claim that autism coverage would raise premiums as much as $7 per person per year, one Representative said, "$7 a year? That's peanuts, we blow that out our gas tank every day."
Rep. Scott Ecklund [left], a Sioux Falls physician, said the state has only two developmental pediatricians, both of whom practice inSioux Falls. One told him that ABA has over 30 years of evidence to support its use as a medical treatment for autism, but that without insurance coverage too few families can access the therapy for their children.
Ecklund went on to mock the insurance industry's complaints about mandates."As a physician, the insurance companies mandate me all the time with their requirements," he said.