Tag Archive for 'insurance'

Insurance woes ahead?

Will changes in California’s insurance system cause children to lose their access to therapies based on applied behavior analysis? According to a story by Chris Megerian in the Los Angeles Times, families could no longer have insurance to help pay costs as the state transitions from its Children in Healthy Families insurance program to one using Medi-Cal. Earlier, Ryder Diaz of KQED had reported similar findings in “Despite Promises, Key Autism Therapy Cut from Medi-Cal.” The children who are served by the Children in Healthy Families program and are therefore at risk for losing their insurance come primarily from families who can least afford the cost of intensive behavioral therapy.

These news reports are supported by documents from the Web site of the Autism Health Insurance Project. On the page MediCal & Healthy Families, the Autism Health Insurance site reported that MediCal was excluded from California’s SB 946, legislation that and California’s Mental Health Parity Act.

Are insurers dragging their feet?

Are some insurance companies slow in providing coverage for behavioral therapies that families deserve for their children with Autism? According to a report by Alan Zarembo in the Los Angeles (CA, US) Times, the problem is great enough in California that a government agency is considering emergency regulations to force insurers to comply with their obligation to provide coverage.

Insurers have been skirting their obligation under recently enacted state law to provide costly behavioral therapies for autism, according to the Department of Insurance, which is proposing emergency regulations aimed at enforcing the law.
Continue reading ‘Are insurers dragging their feet?’

Altering Autism insurance coverage legislation in VA

Writing in the Richmond Times Dispatch, Olympia Meola reported on potential changes in support for insurance coverage for therapy for children with Autism in the Commonwealth of Virginia in the US. Under the headline “McDonnell will try to amend autism bill,” Ms. Meola described developments in Governor Robert “Bob” McDonnell’s plans for altering recent legislation requiring insurance payments for treatment.

Gov. Bob McDonnell is expected today to reveal proposed changes to a bill requiring insurance coverage of autism treatments, and some could be substantial alterations to what the General Assembly passed.

Conversations were continuing as of Tuesday between the governor’s office, lawmakers and interested parties about possible changes to a measure that would require coverage of autistic children ages 2 to 6.

Advocates of the bill said some significant tweaks could be “deal breakers.”

The amendments floated in the past week range in scope, from technical to more substantial, including changes in who could supervise treatment and when the law would take effect, according to those familiar with the proposals.

Link to Ms. Meola’s story.

Bipolar or temper dysregulation disorder with dysphoria?

Under the headline “Time to reexamine bipolar diagnosis in children,” Brendan Borrell reports on proposed changes in the American Psychiatric Association
s Diagnostic and Statistical Manual for the identification of bipolar disorder. In addition to presenting the basic information, Mr. Borrell has alternative views by Dr. Gabrielle Carlson and Dr. David Axelson.

Psychiatrists in favor of a new label, temper dysregulation disorder, cite a spike in bipolar diagnoses. But others worry it will add uncertainty to the treatment of an already confusing condition.

I wonder which side the psychiatrists who were concerned about the change from “manic depressive” to “bipolar” are on with this newest change. Will I have to change the category label in EBD Blog?

Link to Mr. Borrell’s story. Use the short link for this entry: http://wp.me/peQI7-iw

Virginia Autism insurance mandate gains traction

In the Virginia (US) legislature (which I sometimes call the “House of Burgess” for fun), efforts to mandate coverage of intensive behavioral therapy (AKA “ABA,” “discrete-trial training,” etc.) by insurance policies gained a little momentum 16 February when Senate Bill 464 passed by a nearly 2-to-1, bi-partisan margin. Earlier this legislative session, one similar bill (HB 303) was rejected by a narrow vote (4-to-4) in the committee on Commerce and Labor of the Virginia House but another (HB 34) may still be alive (I’m too uniformed about legislative processes to know).

The summary of the just-passed Senate bill, whose chief patron is Senator Janet D. Howell of Reston (VA, US), is as follows: Continue reading ‘Virginia Autism insurance mandate gains traction’

Chelation clinic closed

According to Mary Ann Roser of the Austin (TX, US) Statesman, a clinic that provided chelation therapy for Autism is apparently under investigation by federal authorities. Ms. Roser did not report the nature or cause of the investigation of the CARE Clinics.

CARE Clinics, an autism clinic on Bee Cave Road that was being investigated by insurance companies over insurance claims, was raided by the FBI and IRS agents today.

The clinic has been closed, perhaps permanently.

Agents are removing dozens of boxes of documents, but they declined to say what they are looking for. They directed inquiries to Special IRS Agent Mike Lemoine, who did not immediately return a call.

In an article in May of 2009, Ms. Roser reported that the clinic was having financial trouble.

The owner of an Austin-area clinic that treats children with autism — using techniques that are controversial in mainstream medicine — says investigations by three major insurers have left it with a pile of unpaid claims and a crisis: She’s had to lay off most of her staff and drastically reduce the clinic’s hours.

In addition, Kazuko Grace Curtin said the Texas Medical Board is investigating her medical director. She and the doctor — Jesus Caquias — say the investigation is a way of harassing them because they offer nontraditional care for autism patients.

Link to Ms. Roser’s post entitled “Autism clinic raided by federal authorities” and to the earlier article, “Insurance companies question autism clinic’s charges” Check the discussion following the blog post (the first link).

Consumer Watchdog on Autism therapy insurance

On behalf of the families of two children with Autism, a consumer advocacy groups claims that regulators in California (US) are allowing insurers to deny access to needed therapy. Consumer Watchdog seeks to require the Department of Managed Health Care to mandate that insurers pay for treatment based on applied behavior analysis for children with Autism.

KABC LA coverage

On the heels of the recent agreement in Michigan (US), I have to wonder whether advocates for children with Autism are seeing the beginning of a wave of changes in insurance support for early and intensive behavioral treatment of Autism.

Consumer Watchdog, which was previously known as “Foundation for Taxpayer and Consumer Rights,” has a pretty broad agenda. In addition to insurance issues, it addresses patients’ rights, political corruption, corporate excesses, and other topics. Consumer Watchdog’s site has links to multiple items regarding Autism.

Also see coverage by Lisa Girion of the Los Angeles Times: “Autism patients’ treatment is denied illegally, group says“; Ms. Girion covered this topic previously (see 10 Mar 2009). For other earlier posts on EBD Blog about insurance coverage for children with Autism, see 25 Jun 2009 and 20 Sep 2008.

Insurance and Autism in California

Although insurance carriers in California must pay for some services, in a memorandum to insurers Monday 9 March 2009 insurance regulators in California indicated that insurance coverage does not have to extend to applied behavior analytic (ABA) treatment for children with Autism. According to Lisa Girion, the memorandum from the Department of Managed Health Care requires insurers to pay for speech, occupational, and physical therapy, but not for educational services aimed at improving daily living skills.

The letter is focused on “ensuring that individuals with Autism Spectrum Disorders (ASD) receive the care they are entitled to under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) and accompanying regulations.” It requires that insurers maintain a network of services for evaluation and referral of individuals with ASD that conforms to, Knox-Keene Act. This part addresses screening, diagnosis, qualified providers, and so forth. Under the head “Part B: Treatment for Persons with ASD,” the letter reads

Health plans must do the following:

Cover all basic health care services required under the Knox-Keene Act, including speech, physical, and occupational therapies for persons with ASD, when those health care services are medically necessary.

>>…snip….< < 2. Provide mental health services only through providers who are licensed or certified in accordance with applicable California law. 3. May not categorically exclude any particular health care treatment or therapy for Autism Spectrum Disorder.

So, ABA cannot be expressly denied. As Ms. Girion reported, it must be that the focus of the treatment (e.g., self-care, head banging) that are not considered legitimate targets for mental health. One has to wonder whether speech therapy predicated on behavior analytic principles—and most of the effective speech therapies for children with Autism are based on ABA principles—will become a target.

I have little trouble considering healthy living a mental health issue. Of course, I’m biased, but that might be the path to take. As Ms. Girion notes and the memorandum reads, the Department of Managed Care still requires a process for review of appeals by independent medical providers.

Links to Ms. Girion’s story, “Autism patients in California are dealt insurance setback,” and to the CA Department of Managed Care memorandum.