Bill would cover more autism therapies

by Sebastian Montes | Staff Writer

Health care providers question ‘Applied Behavioral Analysis' treatment

Some changes no mother would miss.

The first that Maryam Muazu noticed was that her 2-year-old son had become more social. Not yet a month in, the cues were conspicuous when the 42-year-old would take Isma to their Montgomery Village home after his daily sessions at a preschool for autistic children.

"He used to ignore everybody, usually he'd just stand apart in the corner," she said Friday, picking Isma up from the Brookeville campus of Community Services for Autistic Adults and Children. "But then he started throwing himself into the fray. Now he initiates play."

Isma's older brother is also autistic. Muazu knew what small strides to look for, and she expects Isma to see the same kind of success. His brother is a student at Montgomery Village Middle School who is mainstreamed in three classes. And for both her children, she credits the progress to a one-on-one therapy called Applied Behavior Analysis.

But her eldest son's success bore a heavy toll on the family. Her husband's insurance did not cover the treatment. Insurance companies say that the treatment is not evidence-based, and that it is an educational, not medical, program. Muazu, who no longer has insurance, was told that the decades-old methods are experimental.

"In a year we spent I think $40,000," she said. Medicaid pays for Isma's treatment.

Long waits, increased costs

Maryland's Autism Waiver Program covers Medicaid-eligible families for a range of services and treatments, until the person turns 21. That leaves 2,700 people on a waiting list for the 900 slots.

"If you were to sign up now, you probably wouldn't see services until about 2014," said Ian Paregol, CSAAC's executive director. "So if you have a child that's diagnosed with autism at about 18 months, well, you missed really an important window. That kid is going to be 7, and the window, really, for a best outcome is that 2 to 6 range."

Thousands of families choose to pay for ABA therapy.

Those stories are what prompted Del. Kirill Reznik to try to force insurers to cover the costs. Paired with a companion bill in the state senate, Kirill (D-Dist. 39) of Germantown is pushing a bill that would require insurers, nonprofit health service plans and HMO's to cover ABA and other early intervention therapies, up to $50,000 per year.

"I've met parents who have mortgaged their homes and are facing foreclosure," he said. "I've met people who have gone into bankruptcy. And more and more people are beginning to really wonder whether they're going to stay in Maryland, or go somewhere like Pennsylvania, where it's covered."

If passed, Maryland would be the eighth state to do so.

Reznik and his fellow District 39 representatives — Sen. Nancy J. King and Dels. Saqib Ali and Charles E. Barkley — have authored or backed more than half of the two dozen autism-related bills introduced this year.

Only a few of the bills are expected to pass. But the spotlight they have shone and the platform they have given advocates has marked a change in the state's approach to one of the world's fastest growing and least understood conditions.

Already finding the axe is Reznik and King's attempt to make state health officials implement an "Adult Autism Care Training Program" that would standardize training and improve wages for caretakers. The bill's fiscal evaluation found that the program would cost the state $250,000 this year and $1.5 million the next. Reznik and King withdrew their bills last week.

Far more momentous is the effort make insurers cover ABA treatment. Autism advocates such as CSAAC, the Kennedy Krieger Institute and Autism Speaks! rallied behind the bills, as did 54 legislators who signed on in support. But with a projected hit to state coffers upwards of $10 million per year, its backers admit the outlook is bleak.

Opponents included Carefirst BlueCross BlueShield, Kaiser Permanente, Aetna, the Maryland Chamber of Commerce and the National Federation of Independent Business.

In a letter to the legislature, the chamber wrote that requiring ABA coverage would "add a significant and uncontrollable increase in the cost of health insurance paid by employers." The state's Department of Legislative Services calculates that requiring coverage will add between $36 and $83 per year per employee in group plans.

"It is not entirely clear what comprises the actual clinical or educational components of ABA," wrote William F. Casey, Carefirst BlueCross BlueShield's vice president of governmental affairs.

More than just fiscal pressures, Reznik concedes that it may be too soon in lawmakers' autism learning curve.

"If it doesn't pass, I'll bring it back next year, and the year after that, until it passes," he said.

Partial solace could come in a pair of bills that would create a state commission on autism. Among its priorities would be to issue, by December, a report on the impacts of forcing insurers to cover ABA therapy.

The hearing on the senate bill is set for Thursday.

This year's session has wrought many of the small increments needed for broader change, CSAAC's Paregol said.

"There's talk about autism now. Before, people would say, ‘Artism?' — they wouldn't necessarily know what it is. So I think it's getting there," he said. "I think that next year will be a very interesting year, because it's an election year. There's going to be a lot of promises made, and I hope there's going to be a lot of promises kept."

More than 50 organizations and businesses will be on had at a county-hosted fair an autism services, to be held 3-7 p.m. April 29 at the Universities at Shady Grove (Building II), 9630 Gudelsky Drive, Rockville. Admission and parking are free. For more information, or for help in attending, call 240-777-1216, 240-777-1217 (TTY) or 711 (Maryland Relay) by April 10.

Source: http://www.gazette.net/stories/03182...47_32471.shtml

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