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| A-CHAMP
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“By Parents, For Our Children” |
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Insurance Coverage
BREAKING NEWS
3/8/07 NYS Legislature Holds Joint Hearing on Autism Read Testimony Reporting Staggering Costs of Adult Care Here Read Submitted Testimony of A-CHAMP President Robert J. Krakow Here
1/3/07 NY Assembly Member Peter Rivera Sponsors New Insurance Bill Covering Experimenal Treatments for Autism – Click Here to Read Bill A. 539
Autism Insurance Bill In Effect January 1, 2007 Bill Prohibits Discrimination in Health Insurance Coverage for Autism Bill Enforces Parity in Health Insurance Coverage for Autism For a pdf file containing the Bill Summary & Text Click Here For A-CHAMP's Letter to Gov. Pataki Click Here A-CHAMP LED COALITION TO REFORM INSURANCE LAWS FOR COVERAGE OF "AUTISM" IS SUCCESSFUL! For Member Organizations of the NY Autism Health Insurance Coalition Click Here A-CHAMP supports insurance reform legislation that requires health insurance coverage for treatment of autism spectrum disorder and related conditions. In 2006 we forged a successful coalition of organizations that advocated for the enactment of Assembly Bill A. 699 and its companion bill in the Senate S. 784. You can obtain a pdf file containing the text of the bill by clicking here and supporting legislative information by clicking here. A-CHAMP also strongly opposes S. 1955, Federal legislation that would preempt state consumer legislation that gives protections against insurance company abuses of the insurance laws. For a pdf copy of S. 1955 Click HERE. To view A-CHAMP's Action Alert opposing S. 1955 and send an email to your Congressional Representatives expressing your opposition to S. 1955 Click HERE. We have witnessed too many horror stories where insurance coverage was denied for a person with “autism” because the insurer deemed the treatment to be for a “mental health” condition excluded under a policy of insurance. There exists a paradox in the evolving understanding of the etiology of autism – emerging research shows that the disorder is biologically rooted while the old paradigm in medicine, psychiatry and psychology views autism as a psychiatric disorder defined by the Diagnostic and Statistical Manual of Psychiatric Disorders IV ("DSM IV"). All too often, a biologically based problem related to autistic spectrum disorder is dismissed by health insurers as a mental health disorder and coverage is denied. Therapies utilized to treat autism such as Applied Behavioral Analysis ("ABA") and others are similarly denied coverage. Whether it is for treatment of a physiological condition or for a recognized behavioral intervention, insurers use the “autism” “mental health” exclusion to avoid paying claims. This practice must end. A-CHAMP's view is that "autism," whether viewed as a mental health disorder or as a biological disorder, warrants insurance coverage. Our position is in accord with the position of leading professional organizations such as the American Psychological Association ("APA"). In testimony before Congress the APA supported enactment of legislation that would mandate coverage for disorders that are currently defined under the DSM-IV or the International Code of Diagnosis 9, such as "autism." In A-CHAMP's view “autism” must be covered, however defined and treated, as long as the treatments have a sound basis in medicine and/or psychology. The cost of services and supports for individuals with the group of disorders labeled autistic spectrum disorder is large and rapidly growing. Our nation is only beginning to struggle with the looming problem of financing the costs of supports and services for those with disabilities. There is universal agreement that early intervention can reduce the long-term lifetime costs of caring for an individual with a neurodevelopmental disability. Denial of insurance coverage blocks early treatment options for most families. A sound policy mandating insurance payment for autism treatments when children are young and can be helped will reduce the long-term costs that must be borne by society through Medicaid and other government programs. We at A-CHAMP know the frightening statistics regarding costs of the autism epidemic. Some statistics suggest the costs for lifetime supports for a person with autism will be at least $5 million including a study completed in the United Kingdom several years ago, although we believe the cost will be far greater – exceeding $10 million for a lifetime of care (see an illustration of how these costs are calculated by clicking here).On March 8, 2007 testimony was presented to the N.Y. State Legislature by the CEO of a long-time not-for-profit service provider for individuals with developmental disabilities. The staggering cost for lifetime care for a severely disabled adult is calculated at almost $18 million. This dollar figure excludes costs for care or education prior to the age of 23 and does not include other costs such as lost earnings for the disabled individual. You can read the testimony documenting these shocking costs here. For a comprehensive government report grappling with some of these issues see the American Council on Disabilities recent report Long-Term Services and Supports: Financing and Systems Reform for Persons With Disabilities. Financing health care for people with autism will save money in the long run. More importantly, it will help persons with autism lead better lives. Enactment of a New York bill that ends health insurance discrimination will be a big step forward for all persons with autism.
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