New Hampshire Bill to repeal Autism Coverage

"The lunatics are on the grass" - editor


BILL COULD STOP COVERAGE

Rindge lawmaker hopes to reduce what insurance companies have to payBy Dave Eisenstadter
Sentinel Staff
Published: Sunday, February 27, 2011

A local Republican legislator says he is trying to undo insurance regulation passed in the last four years while Democrats were in charge.

House Bill 309, solely sponsored by John B. Hunt of Rindge, would repeal a law requiring insurance companies to pay for early intervention autism spectrum disorder treatment. The law went into effect on Jan. 1; its prime sponsor was Suzanne S. Butcher, a former Democratic representative from Keene.

Meanwhile, families and educators attended an Autism and Asperger’s Expo at Antioch University New England Saturday, where autism support advocates denounced the bill.

Kirsten M. Murphy, director of the N. H. Council on Autism Spectrum Disorders and a parent of two autistic children, said the law mandating early intervention autism therapies has further-reaching implications than simple monetary ones.

Out of all young children identified with autism spectrum disorders and treated using early intervention therapies, 47 percent will enter kindergarten at a level equivalent to their peers, and an additional 40 percent will make significant progress, according to Murphy.

Hunt said legislators could ask insurance companies to give them an idea of the new laws’ effects on premiums.

“Now that we have changed leadership, we have a rare opportunity to re-look at all these mandates and get the insurance companies to tell us how much they really do cost,” said Hunt, formerly chairman of the Commerce and Consumer Affairs Committee, which is hearing the bill.

Hunt said it was appropriate for insurance companies — the businesses regulated by these recently passed laws — to provide information that could enact the repeal of those laws. He did not think the businesses would provide inaccurate or misleading information, he said.

Murphy said the law would save money in the long term.

A 2006 Harvard Study conducted by assistant professor Michael Ganz revealed it can cost about $3.2 million to take care of an autistic person over his or her lifetime. Ninety percent of those costs are incurred during adulthood, according to Murphy.

But if treated with early interventions, those with autism have a good chance at being productive wage-earners and tax payers, Murphy said.

Hunt brought the bill forward because Democrats refused to compromise or listen to Republican concerns, he said.

“When I was chair, we compromised more than they did,” Hunt said.

The legislation targeted by Hunt’s bill affects one third of New Hampshire’s population, Hunt said. The laws only affect state regulated health plans and do not affect Medicare or Medicaid recipients or those insured through large employers.

Those with state-regulated insurance are the most vulnerable to insurance premium increases, according to Hunt.

Hunt’s plan is that by reducing the amount insurers have to cover, insurance premiums will also go down. The bill, however, would not mandate insurance companies to lower their premiums, Hunt said.

Without health insurance companies offering access to such treatments, there is no access to them, Murphy said. Schools are not required to deliver medical treatment.

“I think we always have to be concerned about legislation like this,” Murphy said, referring to House Bill 309. “My hope is the Senate will act as a voice of moderation here.”

Beyond autism diagnosis and treatment, the bill takes aim at half a dozen other coverage requirements, including testing for bone marrow donation, obesity and hearing loss.

Murphy said Saturday’s expo at Antioch provided parents and educators needed information about autism treatment and local resources. Among them are an Autism and Asperger’s support group, which meets the second Wednesday of each month, and an autistic child movement group headed by Antioch assistant professor Christina Devereaux.

Fuller Elementary School staff members Jane C. Trombi and Patti L. Vosteen, who work regularly with students with autism spectrum disorders, agreed that the expo was useful.

“I’ve been to a lot of different presentations and a lot of what I’ve heard today is what I’ve heard before: how every child is different,” Trombi said. “Every child needs a different program.”

For Murphy, getting help through early diagnosis and intervention treatments and through participating in events like the Antioch expo is vital for both parents and educators in dealing with autistic children.

“Parents don’t know what to ask for and schools don’t know what to offer.”

Dave Eisenstadter can be reached at 352-1234, extension 1432, or deisenstadter@keenesentinel.com

Defining 'Essential' Care

Regulators Move to Specify Coverage Under Health Law; Insurers Seek Flexibility.

By AVERY JOHNSON
WSJ February 28, 2011

Maggie Haslam's five-year-old autistic son, Drew, has undergone intense behavioral, physical and speech therapy that helped him learn to dress himself and communicate such concepts as "over" and "under."

Drew Haslam, 5, is autistic and has received care that may not be covered under the new health law.
.The therapy greatly helped Drew, said Ms. Haslam, a public-relations agent in Silver Spring, Md. But was it essential?

The next big issue for the federal health law as it moves toward implementation is how regulators will define so-called essential benefits—the basic medical services that health plans must cover under the law.

The legislation gives 10 categories of care that plans must provide for customers of the health-insurance exchanges that are launching in 2014. But the law leaves details up to regulators, who are now starting to develop the rules.

Habilitative services, used by such patients as Drew, have become a contentious point in the debate. Unlike rehabilitation, which helps patients recover skills they have lost, habilitation helps patients acquire new skills. Such services can be costly because the process can take years, and insurers haven't typically covered many of them, sometimes labeling them educational or experimental.

The debate over exactly what habilitative services to include in the new rules—and how much of them—exemplifies the challenge of defining what health benefits are truly essential.

This week, insurers and patient groups are expected to face off at a meeting hosted by the Institute of Medicine, which has been charged by the Department of Health and Human Services with making recommendations on defining criteria for deciding what are essential benefits.

Benefits Questions
Here are the 10 general categories of benefits that the health law considers essential, and some services within each that could trigger debate as regulators develop rules governing insurance plans that will be sold on the exchanges:

Ambulatory patient services

-Varicose vein treatment

Emergency services

-Nonemergency care administered in ER

Hospitalization

-Total hip replacement

Maternity and newborn care

-Fertility treatments

Mental health and substance-abuse disorders

-Unlimited length of stay in a facility

Prescription drugs

-"Lifestyle" medications such as Viagra

Rehabilitative and habilitative services and devices

-Unlimited physical therapy

Laboratory services

-Biometric testing, including genetic markers or DNA analysis

Preventative and wellness services and chronic disease management

-Nutritional counseling

Pediatric services, including oral and vision care

-Braces

Source: WSJ Research .Lobbying on all categories has been intense, and the institute has received over 330 comments from groups including insurers, patient advocates and medical professionals.

America's Health Insurance Plans, the industry trade group, is emphasizing to policy makers and regulators that costs will rise if insurers have to cover too many specific services, and if they aren't allowed to limit the number of reimbursed services.

Insurers want to keep the categories as broad as possible so they have flexibility in designing benefits packages.

Others, especially in the medical and patient-advocacy communities, are pressing for specifics to be set out and coverage limits to be lifted.

"All of it needs to be spelled out because if it isn't spelled out it will be denied," said Andrew Racine, chief of the pediatrics division at the Children's Hospital at Montefiore in New York. He submitted testimony to the institute on behalf of the American Academy of Pediatrics.

Habilitative services have been particularly contentious because they can be costly and difficult to define. A three-year-old child who lost speech after a brain injury would require rehabilitation. But a three-year-old child with autism who has never learned to speak would require habilitation, said Marty Ford of the Consortium for Citizens with Disabilities.

In addition to autism, habilitative services could be used to help children with cerebral palsy learn to walk, children with Down syndrome to acquire language skills or people with schizophrenia to learn basic social skills.

A study by consulting firm Oliver Wyman estimated behavioral programs can cost about $60,000 yearly when a child is young, dropping dramatically after that as he or she becomes more independent.

For Drew Haslam's services, the expenses mounted after a state program for infants and toddlers ended and the family's insurance limited their coverage. Ms. Haslam said they spent $20,000 a year on the therapies until the time and expense became overwhelming.

Because treatments can last years, insurers warn that unlimited coverage could push up the prices of policies that will be sold through the insurance exchanges.

"The legislation raises the question: Are we going to have unlimited amounts of physical therapy? That would add certain costs," said Robert McDonough, Aetna Inc.'s head of clinical policy research and development.

Jeffrey Kang, Cigna Corp.'s chief medical officer, who submitted a statement to the Institute of Medicine in January, suggested that many habilitative therapies might not be included in the most basic plan sold on exchanges, known as bronze plans. Instead, he said, they could be covered starting with the silver plans that are the next most expensive.

"What we are suggesting is that we ought to make the minimum to protect the healthy population against catastrophic events," Mr. Kang said.

Insurers say they want the flexibility to design plans for consumers with different needs. "A 25-year-old doesn't think they will need habilitative care, and they need to be able to afford the benefit package they pick," said Virginia Calega, Highmark Blue Cross Blue Shield's vice president of medical management and policy.

Patient advocates say that consumers shouldn't have to pay extra for habilitative coverage.

"Health care for autism shouldn't be like the sporty option on a car," said Stuart Spielman, senior policy advisor for Autism Speaks, a patient-advocacy organization.

The lowest-level policy should cover all eventualities, said Dr. Racine.

"You don't know if you will need this stuff. That's what insurance is all about."

Write to Avery Johnson at avery.johnson@WSJ.com

Trying to Get Nick’s Law on the Ballot

Filed by Michael Cross
February 24, 2011
KOSU Radio

Supporters of legislation to require insurance companies cover children with autism are upset by a move by the State Speaker of the House that they say will kill the bill.

Supporters of Nick’s Law say the House Speaker moved HB 1624 from the Insurance Committee to the Rules Committee in order to stop it from moving forward.

The bill’s author, Representative Mike Brown says the bill which would have put Nick’s Law before voters was expected to get a fair hearing before it was moved.

“We would have been able to present facts from most every other state save I think three or four other states that have not passed legislation such as this that would actually give children coverage with insurance on this issue.”

House Speaker Kris Steele says since it’s going to a vote of the people it belongs in the Rules Committee.

But, he also admits a program to provide more doctors, treatment providers and therapists just started in January.

“I’m in favor of giving those reforms an opportunity to work before we go down the path of pursuing an insurance mandate that in my opinion will increase health insurance costs.”

Representative Brown says if Nick’s Law doesn’t get a hearing than maybe supporters should look into the initiative petition process to bypass the legislature.

New "Nick's Law" bill gets shuffled into legislative "graveyard"

By Andrew W. Griffin

Red Dirt Report, editor

Posted: February 23, 2011

reddirtreporter@gmail.com

OKLAHOMA CITY – Oklahoma families with autistic children hit another roadblock this week when they discovered the GOP-led House leadership made a last-minute decision to have renewed discussion of “Nick’s Law” moved from the Insurance Committee to the Rules Committee.

The committee was scheduled to meet on Thursday and folks with autistic children had planned to speak to the committee members before learning of the switch. Now, many are having to regroup and reassess with the knowledge that the deadline to get bills out of committee is next week.

It was in January when Rep. Mike Brown (D-Tahlequah) filed a bill, HB 1624, that would allow voters to decide in the form of a State Question on the ballot as to whether insurance companies would cover cost of treating autism for children 21 and younger.

Brown spoke to Red Dirt Report from his office at the Capitol on Wednesday morning and said that the long-term costs to the state will be “astronomical” if these autistic-affected children aren’t treated appropriately before they become adults.

Brown highlighted the sad story of 7-year-old Savannah Martin an autistic child from Lawton who drowned in a pond on Sunday. Brown said the story about Savannah, featured in The Oklahoman, noted how the girl was going to New York state and receiving treatment as well as getting therapy at the ACI Learning Center in Edmond.

The point Brown was making was that autistic children like Savannah respond to therapy and that more can be done for them in Oklahoma.

“She is one of hundreds of children in Oklahoma receiving some kind of help, while others aren’t,” Brown said, adding, “And the argument that (Nick’s Law) will drive insurance companies out of state is false on its face.”

“Let the people of Oklahoma decide if they want to take care of these children now” or later, Brown said. “There is wide support (of Nick’s Law).”

Discussing this change of legislative venue with Red Dirt Report was Wayne Rohde, the father of Nick Rohde, the autistic boy who inspired “Nick’s Law” a few years ago, and has since moved his family from Oklahoma to Minnesota so Nick could get the treatment he needed when Nick’s Law failed to get legislative support.

“People are disappointed,” Rohde said, joking over the phone that he was “stuck in a snowbank” up in the Twin Cities, where he now lives. “ I planned to be there. I wanted (Nick) to come up to the Capitol. Of course everybody remembers what happened last year.”

Rohde was speaking of the decision in 2009 by the House Economic Development Committee to torpedo any chance that the House would get to vote on Nick’s Law. It was a bitter defeat for families who have children battling autism and were seeking coverage.

And now, with House Speaker Kris Steele (R-Shawnee) inexplicably announcing that HB 1624 was being reassigned to the Rules committee, Rohde and others who support Nick’s Law are concerned that HB 1624 will die in the Rules committee.

“(Rules) is traditionally the graveyard,” Rohde said.

An attempt to reach Steele for comment on Wednesday was unsuccessful.

Even though Rohde is hundreds of miles away, he has been keeping in touch with Rep. Brown and friends with autistic children.

Rohde conceded that there is precedent that a State Question should go to Rules, but switching committees “this late in the game,” he noted, proves “They’re not interested in dealing with it.”

“Basically you run out of time,” Rohde said.

Twenty-one other states have passed similar bills into law and as noted in a recent Edmond Sun article, a poll taken in 2010 for SoonerPoll revealed that nearly 80 percent of Oklahomans favored Nick’s Law.

As reported at Oklahoma Watchdog last August, Rohde told that news website that when these Nick’s Law-styled legislation has passed in other states, “free-market health care” kicks in and “..takes over because insurance companies go out and find qualified therapists and set their own rates.”

Rohde was also quoted at Oklahoma Watchdog as saying, “Most of these states see insurance coverage for autism and other special needs conditions as a fiscally conservative approach to health care, a true pro-life position, and the morally responsible thing to do.”

And now, Rohde and other supporters of Nick’s Law are simply hoping to speak their mind and in a committee setting it’s often difficult to do.

“This is a complex issue and we need to have some adult conversations,” Rohde said. “But we’re not able to have them. It’s disappointing.”

Rohde noted how many of the states bordering Oklahoma have already passed Nick’s Law-styled legislation, with Arkansas “getting close to passing it.”

But with no one able to figure out what is motivating Speaker Steele, considering he is not returning calls to Rep. Brown or other interested parties we have learned, one can only speculate what will ultimately happen.

What Rohde does know is that if these kids – who will soon be adults – don’t get the help they need, many could end up homeless or “clogging the jails” and affecting taxpayers in the long term.

But right now there doesn’t appear to be the political will let the people decide if Nick’s Law should become law. Additionally, Rohde suspects that Speaker Steele may be holding off dealing with the autism-and-insurance issue until he is out of his current leadership position.

“I think Speaker Steele doesn’t want to address it until he terms out,” Rohde said.

Copyright 2011 West Marie Media

Arkansas House Committee approves autism insurance coverage bill

Associated Press - February 22, 2011 1:34 PM ET

LITTLE ROCK, Ark. (AP) - A House panel has approved a proposal to require most health insurance companies to cover diagnosis and treatment of autism.

The House Public Health, Welfare and Labor Committee gave its endorsement Tuesday morning to the bill sponsored by Democratic Rep. Uvalde Lindsey of Fayetteville.

Jonesboro native Dayna Miller says her family could have been spared the financial burden it faces today if the measure had been in force earlier. Miller's son Briar was diagnosed with autism when he was three years old, and Miller said she sold her house, took out more than a hundred thousand dollars in student loans and considered selling her own kidney to pay for an intensive therapy that research indicated could help him.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Tea Party. v. Virginia Mandate

The Virginia Tea Party Patriot Federation, the umbrella group of tea party organizations in the state, has come out against a bill backed by House Speaker Bill Howell that would require businesses to provide insurance coverage for children with autism.

"Autism is certainly a heartbreaking condition and the treatments are a terrible financial strain for many families,'' said Mark Kevin Lloyd, chairman of the Virginia Tea Party Patriots Federation.

"The concern of the Virginia Tea Party Patriot Federation with this bill is the inappropriate use of government," Lloyd said. "There is nothing stopping individual insurance companies from adding this coverage themselves as part of free market competition. Virginia, and our nation, has a history of private individuals and groups assisting those who are in unfortunate circumstances. Government is not an arm of compassion, and no matter how well intended, can never replace faith-based and private initiatives."

Howell's position, which all but ensures the bill will pass the General Assembly this year, has upset some members of his caucus, who question supporting a new mandate while opposing the health care overhaul passed last year. Americans for Prosperity, a conservative group that opposes the federal health care overhaul, began robocalls statewide Monday targeting Howell (R-Stafford) that will run through Wednesday's House vote.

The House tentatively approved the bill by voice vote Tuesday and will have final vote Wednesday.

"This is a misguided attempt by Speaker William Howell and a majority of his colleagues in the House of Delegates use government as a tool for compassion,'' Lloyd said. "By doing so they ignore the will of the people and, in particular, the tea party by anonymously voting in support of more big government mandates. It appears they are turning a deaf ear to citizens of the Commonwealth after the overwhelming rejection of health care mandates in the form of ObamaCare."

A similar bill sponsored by Sen. Janet Howell (D-Fairfax) is pending in the Democratic-controlled Senate, where the mandate has typically been supported.

The measure would require health insurers to pay for a specialized therapy known as applied behavioral analysis, as well as occupational, speech and other therapies, for children two to six years old.

The bill would cap annual costs at $35,000 and applies to businesses that employ more than 50 people and are not self-insured. It also covers public employees.

"If passed, (the bill) does nothing to stop a full-on expansion of this coverage, as well as any other mandated coverage the state sees fit, in the near future,'' Lloyd said. "This creates a slippery slope to a nanny-state type of government, eroding away the freedom of choice and autonomy that businesses and individuals enjoy today."