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Department of Education directive affects kids up to age 3
COLUMBUS (Sept. 13, 2013)-- The U.S. Department of Education has direct Ohio to provide ABA for children under age 3 through its federally supported "Help Me Grow" program, stepping into a dispute that is already the subject of litigation.
According to a report in Cincinnati.com, the online news site of the Cincinnati Enquirer,Melody Musgrove, director of the U.S. Department of Education's special education programs, issued a letter tothe Ohio Department of Health statingthat its federally supportedearly intervention services need to include applied behavior analysis (ABA).
ABA for those in the Help Me Grow program was to be made available "to any child who is considered a good candidate to receive it," according to the report.
The letter noted that"the department is monitoring the litigation in Ohio," referring to a federal complaint filed byHollyand RobertYoung after their son Roman was denied ABA coverage under theHelp Me Grow program.The Autism Speaks Legal Resource Center has assisted the plaintiffs in the case.
U.S. District Judge Michael Barrett ordered the state to resume ABA for the child until his 3rd birthday when the Young's school district would then provide the therapy.The case is still in litigation.
Help Me Grow is Ohio's birth-to-three program that provides state and federal funding toOhio's 88 county Family and Children First Councils. The county agenciesprovide home visitation services for expectant parents, newborns, infants and toddlers up to age three who have or at riskfor developmental delays or disabilities, as well as other populations. The program is administered by the state health department'sBureau of Early Intervention Services.
School sees new insurance coverage creating job opportunities
KLAMATH FALLS, OR(September 13, 2013) -- The Oregon Institute of Technology is expanding its graduate course offerings in applied behavior analysis (ABA) to meetthe expecteddemand for more practitioners as the state's new autism insurance reform law takes effect.
"Here is more evidence that autism insurance reform creates jobs," said Lorri Unumb, Esq, Autism Speaks' vice president for state government affairs. "State laws requiring insurance coverage of ABA makes these services affordable and accessible to more families, thereby creating demand for more ABA therapists."
Oregon Tech, which currently offers undergraduate and graduate coursework in ABA,willoffer the first two of a planned nine-course sequence of graduate courses in ABA at its Wilsonville campus starting this fall.
"These courses are designed to provide the rigorous training in ABA that will prepare professionals working in the field of autism to be ready to meet the need for well-qualified, credentialed providers," the institute said in a statement. Oregon Technowoffers a four-course undergraduate sequence that has been approved by the national Behavior Analyst Certification Board (BACB) as meeting the coursework standards for Board Certified Assistant Behavior Analysts (BCaBA).
The expanded offerings are a result of the enactment of SB.365, a law requiring state-regulated health plans to cover ABA, in August. The bill was sponsored by Sen. Alan Bates, a family physician from Medford.
“I am pleased that Oregon Tech has jumped on the opportunity to prepare qualified practitioners to offer these services,” saidBates.
Dr. Maria Lynn Kessler, a professor of applied psychology at Oregon Tech, saidthe Applied Psychology program willpartner with behavior analysts in the Wilsonville area tobring theirexpertise the the new course offerings.
"We look forward to meeting the workforce development needs by offering rigorous coursework in Applied Behavior Analysis to prepare professionals to provide quality services that will make a difference in the lives of children with autism,” she said.
The Oregon law, signed by Governor John Kitzhaber in August,will take effect in 2015 for public employees and 2016 for state-regulated health plans.
The new law establishes requirements for state-regulated health plans to approve and manage autism treatment, including ABA and any other medical or mental health services identified in an individualized treatment plan. To qualify, kids must begin treatment before age 9; up to 25 hours of ABA per week will be covered and continue for as long as medically necessary, regardless of age.
Existing Oregon laws require coverage of autism treatment for older patients and those seeking more than 25 hours of ABA per week.
Autism Speaks joins in successful appeal based on state's 2011 autism insurance reform law
LOS ANGELES (September 11, 2013) -- A California policy that allowed unlicensed but nationally board-certified ABA practitioners to provide therapy under some health plans but declared this illegal for plans covering lower-income families and state employeesis "nonsensical" and void in light of California's 2011 autism insurance reform law, a state appeals court has ruled.
The case was brought by Consumer Watchdog on behalf of state employees covered under the California Public Employees Retirement System (CalPERS) against the state Department of Managed Health Care (DMHC), which enforced the policy. The Autism Speaks Legal Resource Center, represented by Executive Director Dan Unumb, and Robert Barnes, Esq. of Kaye Scholer, intervened as a "friend of the court" on behalf of the successful plaintiffs.
“This decision is a victory for autistic children of firefighters, police officers, and low-income parents as it clarifies that they can't be treated differently than those covered under private health plans,” said Consumer Watchdog attorney Jerry Flanagan.
A trial court in early 2011 ruled against CalPERS employees, concluding that DMHC could require ABA providers to hold a state license in order to be reimbursed by health insurance.
Autism Speaks, Consumer Watchdog and other advocates then worked with California Senate President pro Tem Darrell Steinberg to craft an ABA bill that ultimately passed the legislature and was signed by Gov. Jerry Brown in October 2011. The ABA bill provided that professional certification by the national Behavior Analysts Certification Board (BACB) would be sufficient for ABA practitioners to work in California, allowing their services to be covered by insurance.
The appeals court held that the 2011 ABA law served as an implicit legislative exemption to California's psychology practice act that effectively recognized that unlicensed BCBAs can deliver ABA treatment in California, even under plans like CalPERS and Healthy Families that are not specifically covered by the ABA law.
The court concluded that this exemption had to be interpreted broadly, otherwise a BACB-certified practitioner would be acting legally in treating a child with autism, but if the family switched to CalPERS coverage, the same practitioner delivering the same treatment to the same child would be acting illegally. "Such a result would be nonsensical," the court found.
As a result of the legislation and the lawsuit, “the DMHC can no longer use licensure as a barrier to ABA treatments for autistic children,” said Fredric D. Woocher of Strumwasser & Woocher LLP. “When we filed this lawsuit, HMOs were denying autistic children the most effective medical treatment that is available, with severe consequences for them, their families, and the state's taxpayers. HMOs were blatantly violating California law.
“DMHC's practice of requiring licensure led to the agency's upholding HMOs' denials and delays of this critical treatment for autistic children and their families at the time they need it the most,” Woocher said.
Although the appeals court only required coverage of BCBA-provided and supervised ABA for treatment occurring after July 1, 2012, the court offered strong support for ABA, noting that numerous studies have demonstrated that ABA is the most effective known treatment for children with autism and that the treatment has lasting results.
The 2011 ABA law is scheduled to expire on July 1, 2014. Legislation extending that deadline through 2016 has been approved by the Legislature and sent to Governor Brown.
State licensing issues involving ABA practitioners has frustrated the implementation of autism insurance reform laws in a number of states besides California, including New York, Virginia and Rhode Island and Autism Speaks continues to work through the courts, regulatory agencies and state legislatures to resolve these issues and insure that coverage reaches those in need.