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by Greg_Groogan from Houston

Last Post 8 days, 7 hours Ago


New Autism law - from snake eyes to salvation
May 29, 2007 | 9:12 PM
Category: News
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Just when it looked like families with kids challenged by autism would walk away from the legislative session empty handed - Lawmakers managed to deliver in the clutch what looks like an enormous step forward in a fight that effects one out of every 150 children.

 With three hours to spare HB1919 cleared both chambers. Aboard the bill an amendment re-defining autism in the Texas Insurance Code. In the past this crippling condition has been labeled a serious "mental" or behavorial ailment. As far as Health Insurers were concerned that excluded from coverage a whole host of  treatments and therapies those battling autism consider crucial. With the stroke of his pen Governor Rick Perry will change all that.

When it comes to a child's hyper-critical developmental  years between the ages of three and five - Autism will soon be defined as "medical neurobiological " condition.

What does this mean ? Well, at the very least children in desperate need of early intervention can count on health insurers paying for a whole host of therapies including applied behavorial analysis - a strategy thats produced tremendous outcomes for thousands of kids.

In Texas desperate parents now and in the past have literally impoverished themselves providing these therapies out of pocket - Monday in Austin, Big Insurance was apparently  forced  to step up to the plate.

Okay folks, how big a deal is this ? I want to hear from those who know this ground-breaking legislation well  and hear questions and concerns from those who don't. 

 

 

  

  

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Member Comments Total Comments: 12
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drjim read my blog view my photos
May 29, 2007 | 9:45 PM

Greg,
As you know my wife and I have two children that are within the autism spectrum and this comes as great news! Before moving to Houston we lived in another state and we had to pay for all of our son's therapy...it was worth every single penny, but having "real" help from insurance companies is certainly a step in the right direction. Now let's keep pushing for more reforms!
Jim
hossnfarley
May 29, 2007 | 9:50 PM

Excited for those who are beginning this journey... may they find the research and help to get them through the early days of autism and lead them to an "easier" life ahead... but what does it really mean for those families who see an unending road ahead for these 10+ year olds who were at the beginning of the epidemic that needed these services paid for 5+ years ago?!???? We have put all of our resources into helping our children and, as the woman mentioned on your promo, we have foreclosed on our homes to help our child?!?
Good story... the hope is that more and more become aware of the epidemic of autism and have more compassion for the parents of those children who suffer every day!!! And may more research be done about the effects on siblings of children with autism!!!
akr0376
May 29, 2007 | 9:58 PM

Greg,

I have some confusion as to what this law actually entails. Is the law just for children ages 3-5 yrs old and not beyond that?

I have a son that is nearly four years old who is autistic. At this moment our insurance will not pay for even a single part of his therapy. Will this new law change that? Will the insurance pay for therapy until the age of five or will they continue to pay for a lifetime of therapy if need be? The answer to the question makes the distinction of whether this is a good law or not.

Sincerely,
Amber R.
mvbond01
May 30, 2007 | 12:01 AM

The age "limitation" on the new autism insurance bill was unfortunately necessary because that was the only way the bill would pass. Many legislators, the insurance lobby, and the Texas Association of Business was already up in arms about the extra costs for insurance premiums they feel sure is going to happen even just covering ages 3 to 5. When originally writing the bill, those of us who worked on it were flatly told that anything outside of that narrow age group would ensure that the bill wouldn't pass. We felt it necessary to get the bill passed and get our foot in the door.

That said, there is still an issue in the insurance industry known as "continuity of care". If a person is receiving medically necessary treatment and is receiving benefit from it, the insurance company cannot just end the treatment because someone has reached a particular age. "Continuity of care" should help ensure that a child who needs it should continue to receive necessary medical treatment as long as he is making progress. Additionally, there is also a phrase in the bill amendment which says "if a
child older than 5 continues to need care, the language in this paragraph should not preclude coverage of services described in this section."

So, yes, the bill is limited to ages 3-5, but if treatment is started, the bill cannot be used to end treatment when the child turns 6.
honestanswer
May 30, 2007 | 9:59 PM

I am happy to know that there will be some assistance to those children. It came to late for my brother, who is now 26 and a Severely Austic Adult since he was diagnosised at age 3. With proper medications and opportunities to develop skills to use in the world, he has been able to maintain a fulltime job as a janitor ($10/hr in Dallas) and have a girlfriend who he met through social functions at the local community center.
With the support of the community, friends and open minded families, these individuals can lead lives just like "normal" (define normal someone) and become productive people and help educate us with their meticulous and defined skills.
Greg_Groogan read my blog
May 31, 2007 | 9:38 AM

That's good news about your brother HONESTANSWER.
A recent study estimated only 6% of adults living with autism are employed. In England it's believed only 3% of folks with autism are living independently.
PBMom read my blog view my photos
May 31, 2007 | 11:46 PM

This is a fantastic win. Once the insurance industry sees they won't go broke doing this, perhaps they will be willing to up the age. We need to make sure we thank those who worked so hard on this, especially those in the house/senate. And Hossnfarley, for those of us whose kids are older (Patrick is 11), I'm hoping the Supreme Court decision that we can represent ourselves in due process will be enough to scare the school districts into providing ABA. Just knowing that it will cost us very minimal amounts and it will cost them more to fight parents than to try to work out solutions, even if that means creating precedence, will be the kick in the butt they need to experience the pendulum swing back to creating/re-creating autism units with highly qualified specialized teachers and the program oversight and ongoing training with a BCBA. Sam Houston is about to graduate a bunch of people with newly received BCBAs and they will need jobs. Let's keep those jobs in our state. To Cynthia and her team for getting this accomplished: You are true forces of nature. To those who wrote letters and called: It always matters. To those who didn't write or call: Each individual voice does make a difference; I hope this makes you a believer.
ermurrow read my blog
Jun 1, 2007 | 2:12 PM

I am thrilled that it passed! It's unfortunate that the discussion regarding providing coverage for these children has to center around money, but it does. I am certain that the actuaries at the insurance companies have produced models projecting significant claims in the future to their respective insurers. Those very same actuaries do not consider the staggering cost to society of providing social and health services to these individuals in adulthood if the are not properly treated. I would prefer that therapies such as Applied Behavioral Analysis be provided by the school systems and not the insurers. Of course the school systems invoke the the very same reasons for not doing it as it would cost too much money. The truth is, that it is a far better way of the use of tax dollars to use intensive therapies early in life when the brain can more readily create new pathways than to babysit these kids as many districts do yielding marginal gains. As you said Greg, you can either pay me now, or pay me later.
ermurrow read my blog
Jun 3, 2007 | 12:44 PM

It appears that Governor Perry is receiving intense pressure from The Texas Association of Business to Veto HB 1919. All of us need to hold Governor Perry's feet to the fire and urge him to sign this legislation.
akr0376
Jun 11, 2007 | 8:35 PM

Yes this is a victory for those with autism but what about the children past the age of 5 whose insurance won't pay because the therapy is deemed not medically necessary?

What about my son who is almost 5 and can't get the therapy he needs? We got on medicaid thinking that at least with that we would be able to afford the therapy and now we can't find a single place that will accept medicaid! So our son is receiving no therapy except what I do for him when I can because I am trying to go to school so we can afford at some point to pay for this outrageous therapy!

Sorry for the rant but in my eyes this law just isn't good enough and is not going to make one iota of a diffrence because we already have Early intervention Services which has a sliding scale for those who are poor like us.

We should have demanded BETTER!
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Greg_Groogan

For as long as I can remember, all I've cared about is telling stories about Texans and what matters to them. These days that's pretty much all I do, so I guess I'm livin' the dream. Toss in 2 toddlers and a wife and my life is full to the brim. I'm greedy, I know there are great untold stories out there and I want them all. Help me do it.

Member Since: 3/20/2007


 

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