Protect insurance coverage for children with autism | MinnPost

At 11 months, Kaylee was a typically developing, happy little girl who would say ?mama,? imitate her parents? actions and expressions, wave, and smile at people. Slowly over the next five months, however, she inexplicably started to lose those skills ? no longer speaking or making eye contact, failing to respond when people said her name, and showing no interest in her toys. She was diagnosed with autism when when she was 20 months old, beginning a heartbreaking process for her parents that included almost a year of trying a wide variety of treatments ?including speech, occupational therapy and early childhood special-education services through her school district. ?

Lisa Barsness

After Kaylee struggled to make progress in her other therapies, her parents enrolled her in early intensive behavioral treatment through the Minnesota Early Autism Project (MEAP). It?s working wonders. She?s regained some of her social skills, begun to make eye contact and smile at her big sister and parents, and now plays with some of her favorite toys.

Approximately 20-50 percent of children diagnosed with autism need more than speech and occupational therapy, and are prescribed some form of ?early intensive behavioral treatment (often known as ABA, Lovaas, EIBT, or EIBI). Kaylee?s progress is a very typical example of the success stories my colleagues and I are blessed to see every day.

Unfortunately, the insurance coverage that made this treatment possible for Kaylee and up to 90 percent of Minnesota?s 13,000 families with an autistic child is about to go away. The three largest insurers in Minnesota will have phased out their coverage by the end of the year, each citing competitive pressures.

Unless the Legislature intervenes this session.

Covered for more than a decade

The three largest insurers in Minnesota covered this therapy for more than a decade after the Minnesota Attorney General sued the largest one in 2000. During that time, 33 other states have required insurers to cover this treatment, which is also commonly covered by Medicaid safety net programs and self-insured employers.

The reason for the increase in coverage and support: Overwhelming evidence and extensive research over the past decade shows that it works for a number of children who don?t respond to other therapies. Visit the?Autism Deserves Insurance website?for a summary and links to some of the more significant studies. There is honest academic debate over the single-subject nature of many of the studies, yet that model has evolved to meet rigorous standards as one of the best options for measuring subjective conditions such as mental health research, which simply can?t accurately be assessed by one-size-fits-all randomized trials such as those common for new pharmaceutical drugs.

The cost argument: This type of therapy is expensive, averaging just over $64,000 per child per year in Minnesota. The cost is driven by the intensive and lengthy behavioral exercises that make up the therapy, with goal of eventually weaning them off the treatment if children respond well, as the evidence suggests many do. The therapy includes teaching parents and family members the techniques. It?s truly intensive and intrusive for the family, yet it works. And it?s proven to save society money through these children?s years in school and as adults.

Significant savings in other states

A respected Harvard study estimates the lifetime cost of Kaylee?s disorder to be $2.5-$3.2 million dollars. Think of the savings if two to three years of therapy can reduce or eliminate a decade or more of special education and other social services as adults. It doesn?t work for every child with autism, and we don?t yet have medical and educational savings data for Minnesota; however, other states have measured significant savings from early intensive behavioral treatment For example, the State of Texas estimated savings at:?$208,500 per child in special education services alone. Autism diagnoses are on the rise; currently 1 in 88 children have the disorder, representing a 300 percent increase in Minnesota over the past decade.

Right now there are bills moving through both houses of the Legislature,?HF 181?and?SF 314, and the governor?s?SF 1034?to make sure Kaylee and other Minnesota children like her have appropriate insurance coverage. Please contact your legislator today and share your support for protecting coverage for intensive early intervention autism therapies, and not letting insurers stop short at just covering speech and occupational therapy.

Lisa Barsness, MS, BCBA, is the clinic director of the?Minnesota Early Autism Project.

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Source: http://www.minnpost.com/community-voices/2013/05/protect-insurance-coverage-children-autism

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