Sunday, January 25, 2009

Cooksey, McDaniel support autism plan

Cooksey, McDaniel support autism plan

James Coburn
The Edmond Sun

EDMOND January 24, 2009 12:53 am

Support for legislation targeted to increase the number of therapists for Oklahoma children with autism has the support of state House lawmakers Marian Cooksey and Randy McDaniel, whose districts include Edmond.

The representatives support legislation to increase the number of physicians trained to diagnose and treat autism. Universities would provide certified behavioral therapists specializing in autism.

“We want to help and make a better Oklahoma,” McDaniel said. “I think we both would want to help kids in need. And the more you learn about it, you realize it’s a big problem.”

Autism is a complex developmental disability that typically appears in children before age 3, according to the Autism Society of America. The neurobiological disorder hinders areas of the brain responsible for social interaction and communication.

One in 150 people has autism, according to the Centers for Disease Control. Most of these children are boys. Autism increases at a rate of 10 percent to 17 percent per year, according to the U.S. Department of Education. Eighty percent of these children are under age 14.

“It is a serious problem and I know they need help,” Cooksey said. “We are trying to see all of the areas we can help them without creating such an increase of insurance that would knock off so many other Oklahomans that cannot afford it.”

Blue Cross and Blue Shield of Oklahoma announced in December that autism spectrum benefits will be provided in 2010.

A BCBS overview provided to The Edmond Sun by Cooksey’s office states the autism benefit rate increase will be 0.22 percent to the entire block of business, or a 2.1 percent increase in the child rate.
BCBS benefits beginning at birth would end on a child’s sixth birthday. The annual maximum benefit is $25,000 and the lifetime maximum limit is $75,000. This benefit includes evaluation and management procedures, speech therapy, physical therapy and occupational therapy.

“Obviously if Blue Cross and Blue Shield, which is highly recognized, starts getting in, there will be other private competition for the best product,” McDaniel said. “And it can evolve into something that can make sense where we can actually provide the help.”

A deductible and coinsurance amount is not stated in the BCBS overview. An exclusion for behavioral therapy and experimental therapy is noted.

Behavioral therapy is 80 percent of the out-of-pocket expense that families dealing with autism currently pay for their child’s care, said Wayne Rohde, whose son Nick lives with autism.

“None of us want people to do without the care they need,” Cooksey said. “But at the same time, we can’t just look at one area. We have to look at the whole picture and how we can handle that.”

An independent House and Senate study stated an autism insurance mandate would increase insurance rates by 7.8 to 19.8 percent.

In 2007, The Council for Affordable Health Insurance, a research and advocacy association of insurance carriers, reported insurance mandates regarding autism would increase the cost of health insurance premiums for consumers in 10 states by 1 percent or less.

The proposed Nick’s Law would provide insurance coverage for the early diagnosis testing of autism and medications until the child reaches age 21.

In March, Nick’s Law went to the House Economic Development and Financial Services Committee after winning Senate approval 39-9. Nick’s Law was blocked by the House committee’s chairman, Rep. Ron Peterson, R-Broken Arrow, when he denied giving it a hearing.

“We have a huge overriding goal. We want more people to have insurance,” McDaniel said. “Then, the other side of the table would say we have these different categories we need to ensure that they’re being taken care of.”

He said lawmakers must be prudent not to pass insurance mandates that most people cannot afford.

Funds from the Oklahoma Department of Human Services available for children with autism were not being used due to a lack of autism experts in the state, Cooksey said. This DHS pilot program was to involve 30 children combined from the Tulsa and Oklahoma City areas, McDaniel said.

“Somewhere between $8,000 and $12,000 per family was not spent,” Cooksey said. “We don’t have doctors that know that much about it.”

In addition, the proposed law would enhance Sooner Start for disabled children 3 years old or younger. And it would support privately-funded research efforts for autism.

“There will always be groups that want us to do more. In a tough (financial) year, I think we’re making a significant step forward and I feel good about us making good efforts,” McDaniel said.

In 2008, Cooksey assisted Rep. Ken Miller, R-Edmond, in passing legislation that provides funding for a master’s level teachers training program focusing on autism behavioral problems. Twenty-six teachers in the program are preparing to complete their first year of training, Cooksey said.

“They would be able to help diagnose the problems in school,” Cooksey said.

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