Nj bill on Autism insurance closer to becoming law

BRUCE SHIPKOWSKI
The Associated Press

TRENTON, N.J. - A measure that would expand health insurance coverage for autism and other developmental disabilities in New Jersey may soon become law.

The bill requires insurers to cover the cost of autism treatments deemed medically necessary, such as physical, speech and occupational therapy, along with behavioral intervention. The Assembly overwhelmingly passed it Thursday.

That came a week after the Senate approved the measure, which would cap coverage at $36,000 annually for patients ages 21 and younger.

The bill now heads to Gov. Jon Corzine, who is expected to sign it into law soon. If that happens, New Jersey would be the 14th state with such coverage requirements.

"Families that have a loved one with autism should not be expected to shoulder the financial hardships of this disorder alone," said Vincent Prieto, D-Secaucus, who co-sponsored the bill with Assembly Speaker Joseph Roberts Jr., D-Brooklawn, and Assemblywoman Joan Voss, D-Fort Lee.

"Requiring health insurers to cover therapies for autistic children early in their lives ensures they receive the treatments they most need when it will make the greatest impact," Prieto said.

A Federal Centers for Disease Control and Prevention study found that 1 in 94 New Jersey children have the disorder, compared with 1 in 152 nationwide.

Autism is considered a genetic-based disorder. Its cause has not been pinpointed and there is no known cure. The symptoms are wide-ranging and include poor speaking and eating abilities, self-inflicted injuries and inappropriate crying or laughing, according to Autism New Jersey.

"Treating autism spectrum disorders early ensures that these children learn basic life skills, which can have lifelong impacts, often mitigating some of the challenges faced by many adults with autism," Voss said.

Some people with autism have trouble learning how to do the simplest tasks, and supporters of the measure say insurers often do not cover needed treatment, or if they do, the coverage is for a limited time. Opponents, while sympathetic, contend it will drive up health care costs for small businesses.

N.J. Senate committee advances bill expanding coverage for autism therapy

by Elise Young/Statehouse Bureau
Monday June 15, 2009, 6:33 PM

TRENTON -- Health insurance would cover treatment costing up to $36,000 a year for New Jerseyans with autism and other developmental disabilities, under a bill that cleared a Senate committee today.
Twelve states have approved such a law to cover behavioral, occupational, physical, speech and other therapies that insurers sometimes deny because they are not considered restorative. New Jersey would cap the coverage at $36,000 for 2011, and adjust the figure for inflation each year.

The measure was approved by the Senate Budget and Appropriations Committee today and will now head to the full Senate for final legislative approval. The Assembly passed it about a month ago.

"More and more states are recognizing the need to pass this legislation," Stuart Spielman, a policy adviser and counsel to Autism Speaks, told the committee. "Given the severity of autism spectrum disorders for many people, providing comprehensive care is the best way . . . to realize savings down the road."

New Jersey has the country's highest rate of autism, with one in 94 children affected, according to the federal Centers for Disease Control and Prevention. Nationwide, the average is one in 150 children.

Autism affects an individual's ability to communicate and socialize. Its symptoms can be barely noticeable to completely debilitating, and it has no known cure or cause, although genetic and environmental factors may contribute.

Some of the treatments entail expensive, evolving therapies that work well for some, but don't work for others. During past legislative hearings on the bill, some parents described depleting savings to pay for care for which they were not reimbursed by their health plans.

One treatment involves "teaching" a person with autism to identify a companion's emotions -- smiling, for instance, or crying -- and reacting appropriately. Others aim to redirect compulsive behavior, such as banging one's head.

"The committee should be applauded for recognizing this legislation as an incredibly sound and compassionate investment," Assembly Speaker Joseph Roberts (D-Camden) said in a statement. "The greatest cost would be the cost of doing nothing, not only for those trying to break through these disorders and their families, but for the taxpayers of New Jersey."

N.J. bill would require autism-treatment coverage

N.J. bill would require autism-treatment coverage

By Cynthia Henry

Inquirer Staff Writer

TRENTON - After testimony from parents who had depleted their savings to provide treatment for their autistic children, New Jersey Senate and Assembly committees yesterday advanced a bill that would require insurers to cover screening and therapies related to the disorder.

"If my child had cancer, diabetes or fetal alcohol syndrome, she would be covered," testified a tearful Hilary Downing of Readington, Hunterdon County. "The college savings of my older daughter is gone."

Autism is a developmental disorder characterized by repetitive movement and severe deficits in communication and social interaction. Researchers have found New Jersey to have a high prevalence of autism, for which there is no known cure.

"I don't know of any parent who wouldn't do everything in their power to give their autistic or developmentally disabled child every chance to excel," said Sen. Loretta Weinberg (D., Bergen), a bill sponsor. "However, the enormous cost of behavior intervention . . . makes it out of the realm of possibility for many families."

The Assembly may vote as early as Thursday. The Senate bill has moved to the Appropriations Committee.

Ten states, including Pennsylvania, have enacted legislation requiring coverage of autism treatment. Most of the laws cap benefits and the age of those covered.

Similar to Pennsylvania's law, which goes into effect July 1, New Jersey's bill would provide developmentally disabled patients under 21 with insurance benefits of up to $36,000 a year for diagnostic services and behavioral early intervention, as well as occupational, physical, and speech therapy.

"In this economy, every New Jersey resident is struggling, but families with kids with special needs are struggling even more," said Assembly Speaker Joseph Roberts Jr. (D., Camden), who also sponsored the bill. "They're maxing out their credit cards and taking out second mortgages" to cover gaps in insurance.

Holly Masclans broke into tears as she testified that she had mortgaged her Haddonfield home three times and drained her older daughter's college fund to obtain $750,000 in behavioral and other therapies for two children with autism. "The only thing left that hasn't been treated is their stuttering, but we're broke," she said.

Roberts called expanding insurance coverage the "most significant piece of unfinished business" after passage of seven autism bills since 2007. New Jersey has improved early detection, increased research funding, studied needs of adults with autism, and created training programs for teachers and first responders.

The Legislature acted after the Centers for Disease Control and Prevention reported in 2007 that New Jersey had the highest autism rate among 14 states it was studying. Researchers found autism symptoms in one in 94 New Jersey children, compared with 1 in 150 in the other states, including Pennsylvania. Roberts and other witnesses yesterday attributed the state's rate, in part, to better diagnosis.

U.S. Sens. Robert Menendez (D., N.J.) and Bob Casey (D., Pa.) and Rep. Chris Smith (R., N.J.) are sponsoring federal legislation to expand autism insurance coverage.

No member of either New Jersey state committee objected to the measure. Two Assembly members abstained.

The New Jersey Business and Industry Association and New Jersey Association of Health Plans opposed the bill because of cost concerns.

As employers' insurance plans become more expensive, workers lose coverage, Christine Stearns, the business association's vice president for health and legal affairs, said in an interview. "How, who, and what is part of a basic health plan is all part of that," she said.

Stearns said that the bill was an improvement to previous versions because it required services to be medically necessary and prescribed; included a reasonable price cap; and ensured that the cost of educational services provided by schools would not be not shifted to insurers.

Roberts said improved coverage would enable earlier treatment and prevent costlier problems later. He referenced a University of California, Los Angeles, study that showed that 47 percent of autistic children who received early behavioral treatment went on to be "indistinguishable from their peers" and started elementary school in mainstream classes.

The annual cost difference between special education and regular-classroom instruction in New Jersey is nearly $37,000, he said. In the long term, he said, the state also would save on adult and institutional care.

The lifetime cost of caring for a person with autism is about $3.2 million, Harvard psychologist Michael Ganz estimated in 2006. In his study, the first to document the societal price of autism, Ganz suspected that parents' out-of-pocket expenses were underestimated.

Lisa Bilsky of Princeton said she spends hours on the telephone arguing about coverage for her 10-year-old son. Last week, she said, a claim was denied for a developmental pediatric visit. Even for benefits her insurance provides - such as occupational therapy - her son must frequently be recertified as needing treatment.

Autism is "not like you sprained your ankle. It's not going away," she said.

"A Genetic Clue to Why Autism Affects Boys More."

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World Autism Awareness Day - April 2nd, 2009

Many challenges come with raising a child with autism. Parents are often faced with issues like choosing appropriate screenings to determine symptoms and severity. Or the best course of treatment to help their child live a normal life. And when they're school age, what track do they put their child on. Would a special-education setting hinder or support their needs?

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