Bad Medicine : Every one will pay for inaction on autism legislation

BY ARNOLD HAMILTON


...So let's get this straight: The Republican-majority Oklahoma Legislature is seriously discussing a bill that could make it more difficult for regular folk to circulate initiative petitions and get them on the ballot?

The same Oklahoma Legislature that itself placed 10 of 11 referenda on last year's ballot -- most wedge issues designed to ignite turnout among constituencies that tend to favor the GOP majority?

The same Oklahoma Legislature whose Republican members for years huffed and puffed about Democrats "not trusting the voters" to decide important issues?

The same GOP majority Oklahoma Legislature that refused this year to let the voters decide whether insurance companies should be required to cover treatment for children with autism?

Seriously?

All you need to know about what who wields the real power at N.E. 23rd Street and North Lincoln Boulevard in Oklahoma City is this: Big insurance's deep pockets can deftly turn referenda-happy Republicans into a referenda-killing machine.

Oklahoma families crushed by the costs of uninsured treatment for their autistic children have worked vainly for several years to get relief from their lawmakers. But there hasn't been an insurance mandate since Republicans took control of the state House six years ago -- the last one ordered was for mammograms.

And before you start grinding your teeth about "mandates" or "government regulation" or "interfering with free enterprise," remember this: 1 in 100 children is now diagnosed with the malady.

This is a ticking time bomb -- for Oklahoma taxpayers. You see, children treated for autism often can become productive, taxpaying adults. If they are not treated, who do you think will most often end up paying for their adult long-term care and housing? Exactly -- the taxpayers. And the costs are likely to be enormous.

Big insurance feigns poverty, but the truth is, companies are earning record profits. Moreover, there is plenty of evidence that treating children with autism isn't burdensome for these companies that clearly care about one thing and one thing only: their bottom lines.

Already, 21 states have passed legislation that mandates some form of autism treatment for children. Oklahoma lawmakers, meanwhile, play a cost-shifting game -- protecting big insurance (among their biggest campaign donors) and leaving a mountain of future expenses to taxpayers.

Why should current legislators care? They'll be term-limited from office before the you-know-what-hits-the-fan. Future lawmakers can clean up the mess.

What's even more appalling is that Oklahomans overwhelmingly believe a mandate is warranted -- 79.5 percent in a SoonerPoll last spring. In addition, 66.6 percent of the likely voters surveyed statewide said they would favor a state ballot initiative requiring health insurance to cover the diagnosis and treatment of children with autism.

So, Democratic Rep. Mike Brown of Tahlequah introduced legislation this year that would give voters the chance to decide the issue. It looked like the perfect plan: How could the Legislature's Republican majority -- which prattles endlessly about "trusting the voters" -- not trust the voters on this issue?

Initially, Brown's HB 1624 was assigned to the House Insurance Committee. But in late February, it was shifted to the House Rules Committee -- the graveyard for legislation the speaker and powers-that-be want to kill.

Brown says the speaker told him he wanted to let last year's legislatively enacted reforms take full root before considering a statewide vote on the issue. What reforms? Lawmakers approved a measure aimed at increasing the number of health care professionals in Oklahoma with expertise in treating the malady.

It was pure window dressing -- more treatment will be available for those who can't afford it. And what is likely to become of those new autism-care professionals, trained at state taxpayer expense? Most likely will end up practicing in other states that demand insurance companies to cover treatment for autism -- states like all our neighbors: Texas, Missouri, Kansas, Colorado, New Mexico, Louisiana and Arkansas.

Brown hasn't given up. He proposed an amendment to Speaker Kris Steele's HB 2130 that addresses the duties of the Health Care for the Uninsured Board that would mandate autism coverage. It's time, Brown says, for "an honest and open debate about the lifelong consequences of failing to provide these services in crucial developmental years."

"In the end, it's not just the children but also the families who will pay for our inaction on this issue. The emotional turmoil parents face when unable to provide proper medical care for their child is unimaginable -- especially as more studies are released that prove the powerful impact early intervention can have on a child."

You can bet Republican legislative leaders will work to kill this proposal, too. But it only serves to reconfirm their venality -- big insurance mercenaries who are callous to the plight of suffering Oklahoma families and indifferent to the catastrophic costs that will be borne by Oklahoma taxpayers.

Even worse, the state Senate recently approved Senate Joint Resolution 37 that would place a referendum on the ballot aimed at making the initiative petition process even more difficult.

Currently, those seeking to place a measure on the ballot can collect signatures anywhere in the state. Most, as you might guess, focus their efforts in the state's two largest metropolitan areas -- Tulsa and Oklahoma City -- with about two-thirds of the state's population.

Sen. Mike Schulz's plan -- which would be put to a statewide vote if also approved by the House -- would amend the Constitution to require a percentage of the signatures come from each of the state's five congressional districts.

"It's simply to bring some equality to the process," the Altus Republican says.

You can't simply sit in a metro area and gather all the signatures needed to get something on the ballot."

I've long argued that lawmaking-by-initiative is a dicey business. We have representative government for a reason -- we elect and pay (handsomely) proxies to go to the Capitol, study the issues and make their best judgments while we carry out our everyday lives. If we don't like the way our representatives vote, we elect someone else.

As far as I'm concerned, 11 state questions on the ballot last year was way too many. But I find it more than a little ironic that Republicans who were responsible for placing 10 of them on the ballot in 2010 now are working to make it more difficult for non-elected officials to petition their government.

Either you trust the voters or you don't.

--(Arnold Hamilton is editor of The Oklahoma Observer; okobserver.net)

Nick's Law falls short again in the OK Legislature

COMMENTARY

The City Sentinel
By Wayne Rohde
March 10th, 2011

As the Oklahoma Legislature closes out the first month of this new session, I am concerned that Oklahoma is missing out on a great opportunity to say to the world, to say to this nation, that we rise above politics, we rise above the rhetoric that divides us on some many levels, and tend to the needs of those in our society are the most vulnerable, those with special needs.

For the past several years, the Legislature has seen a surge in the advocacy of parents, medical practitioners, and concerned citizens to pass Nick’s Law, legislation to require insurance companies to provide medical coverage for treatments and therapies that are medically necessary to combat the symptoms of autism.

And for the past several years, the Legislature, instead of discussing and debating the complex issue of insurance coverage for children with autism, have sided with the special interests that control the state capitol, and have continued to turn their backs on the most vulnerable members of our society.

During this session, Speaker Kris Steele, at the last moment, moved HB 1624 out of the House Insurance Committee where it was scheduled to have a public hearing, to the House Rules Committee, where it will die. This action is very typical of the House since we first introduced Nick’s Law in 2008. They find ways to kill the bill instead of allowing the members vote on the bill on the floor of the State House.

But we will not be defeated. We will not turn our backs on our children and we will prevail. The costs are too high if we don’t. Many of our children can be removed from the iron claws of autism and become self sufficient taxpayers of the future. But to continue turning our backs and kicking this problem down the road, the taxpayers will be faced with a large burden of providing state services for these children who will become adults and require around the clock care. It is truly a fiscally conservative approach to address this problem now instead of spending 20 to 30 times the cost in the future.

For those in opposition that often quote that passage of Nick’s Law will only drive up insurance rates in Oklahoma, I have this question. If so, then prove it. Show us the credible economic data that shows that Nick’s Law will drive up insurance rates significantly. I can help you with your research. There is no credible data. Simply put, in the other 23 states that passed similar legislation, there has been no significant increase to premiums.

For those in opposition that Nick’s Law is nothing more than government run health care, please look carefully at the states that implemented this legislation. I will argue that it creates a more efficient free market system after in acting this mandate. Insurance companies will contract with medical providers, creating a demand for qualified therapists and doctors to open up clinics and create hundreds of medical jobs, and provide a greater access to health care for all.

For those in opposition that Nick’s Law will only serve a small number of children, these providers will be able to serve not just those with private health insurance but those with TriCare, SoonerCare, and the self insured.

This is all evident in the states that have passed similar legislation. I will take this evidence as something that can be replicated in Oklahoma. And take a look at our neighboring states, we are surrounded by states that clearly understand this issue and have moved forward to address this epidemic. But Oklahoma seems to continue to lag behind the nation in health care rankings.

Last year, SoonerPoll conducted a statewide poll on if the voters of Oklahoma would support Nick’s Law. In one of the largest favorable outcomes, 79.5% of the voters support Nick’s Law with a surprising 70% of Republicans. This should not be a partisan issue and with this poll, it is clearly has bi-partisan support. The results show that this issue transcends across all demographics of political party, economic divisions of income levels, and religious beliefs.

But our state legislature and now Speaker Steele has decided once again to listen to the special interest groups and lobbyists instead of the voters of Oklahoma. The voters understand the issue and now it is time for the legislature to represent the people of Oklahoma, not the selfish interests. So I call on Speaker Steele to allow Nick’s Law to come to a vote of the people. HB 1624 asks for it and the people of Oklahoma demand it.

Ark Gov signs autism insurance coverage bill into law

LITTLE ROCK, Ark. (KTHV) -- Gov. Mike Beebe will sign into law a bill requiring insurance companies to cover autism diagnosis and treatment.

There is new support for autistic children in Arkansas. Tuesday, Governor Mike Beebe signed an autism bill into law. It requires most health insurance companies to cover autism diagnoses and treatment for children under 18.

It's a signature with the power to lift a financial weight. Ten-year-old Briar Miller with his mom Dayna were in the center of it all. "I'm glad the law passed we've been trying to pass it for two years," says Briar Miller.

Most major health insurance companies can no longer deny Arkansas families coverage for treatment for children with autism. "I just truly believe that children in Arkansas deserve the same right as children across the United States especially when it was a research proven approach," says Dayna Miller.

Miller estimates she borrowed $100,000 to pay for applied behavior analysis. It's treatment using positive reinforcement recommended by the National Institute of Child Health and Human Development. Miller says for Briar it works. " He went from a nonverbal child, he's in the fifth grade getting straight A's although he brought home a B last week that's we're going to get up," says Miller.

The CDC estimates that 1 in 110 children are diagnosed with autism and that ABA treatment ranges anywhere from 30 to 60 thousand dollars a year.
Veronica Tess Myers says in 1996, when doctors diagnosed her son Alexander with severe to moderate autism.

You definitely feel alone, there's a lot of tears being cried there's a lot of frustration there's a lot of sitting alone trying to figure out what the next step is going to be to help you child to succeed," says Myers.

They told her told her it was either ABA or a group home for life. "And that's the part that breaks my heart that so many families want to help their child and couldn't get therapy," says Miller.

Danya Miller says she was working at a factory when Briar was born. She went back to school and became a speech pathologist to help him and other children with autism. Arkansasautism.org ­estimates that one in 93 boys and one in 345 girls in the state are autistic.

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

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."

Minneapolis - City Pages IEIBT could cure autism

But HealthPartners and other insurance companies won't pay for it

By Nick Pinto Wednesday, Jan 26 2011

Tracy Reid was bawling uncontrollably, and the medical specialist sitting across from her couldn't understand why. She had just told Reid that her five-year-old son Max scored normally on a battery of mental tests and had an average IQ. What was there to cry about?

Max Reid, now five, was diagnosed with autism in 2008

Tracy Reid used to fear that the kiss in this photo would be the only one she'd ever get from her son. Thanks to Max's therapy, she no longer worries that he'll need a lifetime of institutional care.

Through her tears, Reid tried to explain: The assessment of Max brought to a close three years in which the single mother thought her son would never be normal, would never be able to go to college, would never be able to take care of himself.

Reid hadn't let herself cry since Max was diagnosed with autism. He showed many of the obvious signs: He didn't like to be close to other people, wouldn't make eye contact. He was slow to learn to talk, and fell behind the curve in picking up the skills most young children learn. He threw violent tantrums.

On her dresser at home, Reid kept a picture of what would probably be the only kiss Max would ever give her. Captured against a photography studio backdrop, the shot shows Max lunging at his mother in a bizarre, open-mouthed embrace.

Shortly after the picture was taken, Max became so uncomfortable with physical contact that kisses were unimaginable.

When Max was diagnosed with autism in 2008, the outlook wasn't good. His IQ classified him as mentally retarded. On the Global Areas of Functioning scale, a way of measuring how well you fit into society, he scored an abysmal 45. Reid wouldn't admit it to herself at the time, and even now feels ashamed to say so, but as the scope of Max's problems became clear, she felt like she was grieving the loss of her son.

Still, she wasn't ready to give up on him. She had health insurance through her work as a lawyer at the Legal Aid Society, and set about looking for treatments that could help Max. Eventually, she found the Minnesota Early Autism Project, which has had good results with a form of treatment called Intensive Early Intervention Behavior Therapy, or IEIBT.

Click the title to read the entire article

Rep Mike Brown introduces HB 1624 Vote of the People for Nick's Law

Fox 25 News Oklahoma City
Jan 21, 2011

Oklahoma City - Rep Mike Brown has filed HB 1624 which will allow the voters of Oklahoma to have the final say on Nick's Law if passed by the state legislature.

Click here to view the video.

Shelley Hendrix Reynolds: Oregon First State to Introduce Autism Insurance Reform in 2011

And we're off!

It's easy to tell the first Monday back after the New Year in the Government Relations department at Autism Speaks. It's full of sparks as rockets start taking off in every possible angle in the race to introduce autism insurance reform legislation in the states. States spend all fall hammering out policy details, knitting coalitions and growing their grassroots advocates and then BANG! It's off to the races. This mad pace continues throughout the first half of the year in the scramble to see whose states will achieve the objective this spring legislative session.

This January, Oregon entered the fray as the first state of 2011 to introduce autism insurance reform legislation with both a House and Senate version of the bill. Oregon has a legislative session that only meets during odd years. The team of volunteers in 2009 worked very hard but we just didn't reach this objective. We know more now. We are armed with more data and more states have enacted legislation. Oregon's volunteer leaders have spent time cultivating that fresh ground and sowing the seeds necessary for success.

Their time is now.
When you look at our map of the United States you see a swath of green across the nation utilized to signify the 23 states that have passed this legislation in the heartland, along the Gulf Coast and up the Eastern Seabord. But the west coast has remained unphased. All children with autism need appropriate health care coverage.

How is it possible that our nation has an entire coast where no coverage exists for our children to access the treatment and therapy they need?

2011 is the year to resolve that injustice. And Oregon Autism Advocates, I hope you will get involved and change your children's destinies.

Martin Luther King, Jr. once said, "Change does not roll in on the wheels of inevitability, but comes through continuous struggle."

With Martin Luther King, Jr. day this past Monday, if you live in a state that has not yet turned green, listen to his words and let that motivate you. Do not give up. Do not sit quietly and depend on others to do this hard work for you. Roll up your sleeves, get busy and get it done. It is worth the struggle.

Yesterday, I spoke with a parent from a state whose law was recently implemented. Their child is severely affected by autism -- and is a teenager. Their family had lost hope. With the advent of the child's new ABA therapy program, because they have access to this treatment, he is now learning independent skills. He is making small meals for himself. He is doing his laundry. He can perform chores around the house. He is contributing to the family unit and because he is more engaged it has changed the dynamic of the family's life and his. These laws are changing lives. They can change yours.

If you live in one of the 27 states that have not passed autism insurance reform and want to get involved to change than visit www.autismvotes.org and sign up today.

Good luck, Oregon. We are rooting for you!

Michigan Lawmakers discuss autism insurance coverage

Jan 20, 2011

LANSING (AP) -- Michigan lawmakers are renewing efforts to require the offering of insurance coverage for certain autism treatments.

Bills were introduced this week in the state Senate. Democratic Sen. Tupac Hunter of Detroit said Thursday the insurance coverage is needed to help families that can't afford the costs of certain autism treatments for their children.

More than 20 other states have similar laws, but the Michigan measure is opposed by business and insurance groups that say mandating coverage would raise the cost of employer-sponsored health insurance.

Supporters of the measure say it's an issue of fairness and that it would save Michigan money in the long run.

The proposal to require autism insurance coverage stalled in the Senate last year. Bills are being reintroduced for the 2011-12 legislative session.

(Copyright ©2011 by The Associated Press. All Rights Reserved.)

Virginia Autism Project pushes for insurance reform

VAP taking two bills to the State Senate

January 17, 2011|By Bob Grebe | Reporter

The Virginia Autism Project is hoping the General Assembly will take up Autism insurance reform.

The VAP website lists two bills the group is supporting this year. SB 1061 - Coverage for Autism Spectrum Disorder; relating to the state employee health benefit plan. This bill only covers state employees. SB 1062 - Relating to health insurance coverage for Autism Spectrum Disorder. This bill excludes state employees.

According to the VAP there are specific reason for the separate bills:


"1. Several legislators last year were concerned that our bill excluded state employees. 2. If state employees are included, then the bill has a fiscal impact for the state budget and we have been told, nothing will pass that costs the state money. 3. SB 1062 does not have a fiscal impact for the state and if the legislators want to ensure coverage for state employees, then we have a bill that will do that and they can support SB 1061 without endangering SB 1062 by giving it a state budget impact."

Lavada Robertson of the Virginia Autism Project is hoping meaningful insurance reform will pass this year.

"We have to start somewhere and this is it," said Robertson. "The Autism community needs to come together to get this accomplished."

VAP officials say this approach is a good first step for establishing the costs of autism treatment to the insurance industry.

According to the VAP, Texas passed similar legislation in 2007. The group is hoping everyone will get involved in the process.

"Autism affects 1 in 110 children and is growing rapidly," said Robertson. "We ask that you call and email your Delegate and State Senator and ask them for a favor, to co-patron the Autism insurance bills introduced by Senator Janet Howell."

W. Virigina Flash Mob Raises Autism Awareness

Click Here to see the video.

CHARLESTON, W.Va. (WSAZ) -- As people headed into the Capital Classic Wednesday night, they probably noticed something was a little different this year.

A large group of people suddenly came together to speak out about an issue affecting thousands of families.

They're trying to get better health coverage to help kids living with autism in West Virginia.

Sonja Almonte says she sang a rendition of "Lean on Me," along with dozens of other people "because my first-born child was diagnosed at a year-and-a-half."

"My son, my 8-year-old son Logan, was diagnosed with autism when he was three years old," says Del. Denise Campbell, D-Randolph.

They're among thousands affected in many different ways. For some people diagnosed with autism, joining in the chorus isn't even possible.

There are treatments available, but they come at a steep price.

"We actually gave up our dream home to be able to provide services for our child," says Earline Anglin. "And, we're so thankful that we did because he's done very well."

Del. Mark Hunt, D-Kanawha, has a child living with autism.

According to the Centers for Disease Control, one out of 110 kids has an autism spectrum disorder.

Hunt says, "We're in the middle of an epidemic here. And the problem is not so much the price now, but what's it going to cost to take care of these people when they reach adulthood?"

He's pushing for a bill that would require insurance companies to cover people with autism.

Sometimes, those treatments can cost tens of thousands of dollars a year.

"It's embarrassing that 35 or 40 other states, most of them bankrupt have already had the foresight to pass this bill. And, I think we just feel like there's a need to do it now," Hunt says.

Hunt says he expects a bill to be introduced to the Legislature as early as Thursday.



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ND lawmakers say autism bill needs more study

Editor's note. ND state Rep Bette Grande stated that the bill is too broad and needs more study. Translation, insurance lobby has a strong advocate in Rep Grande. There are 23 other states that have focused the legislation. No different in North Dakota.

Published: Tuesday, 26 Oct 2010

BISMARCK, N.D. - Lawmakers say they're not ready to push the North Dakota Legislature to support mandatory insurance coverage for autism therapy.

On Tuesday, a legislative benefits committee declined to recommend a bill to require coverage. The Legislature is likely to take up the proposal anyway next year.

More than 20 states require insurance companies to pay for autism treatment, which can cost thousands of dollars a year.

Advocates for people with autism say it helps alleviate the condition. Autism is a brain disorder that affects a person's ability to relate to other people.

Fargo state Rep. Bette Grande (GRAN'-dee) is chairwoman of the committee. She says the bill's insurance coverage requirement is too broad and the subject needs more study.

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Announcing The Combating Autism Act Reauthorization Coalition

Courtesy of our friends at Age of Autism.

President Bush signed into law the Combating Autism Act (CAA) on December 19, 2006. This landmark legislation authorized $700 million in research funding over five years and set the goal of finding the cause (including possible environmental causes) and treatments for autism. The Act sunsets on September 30, 2011.

A coalition of leading community organizations is coordinating an effort to seek reauthorization and has prepared a list of Guiding Principles. A broad consensus on these principles is the essential first step before legislation can be crafted to implement these ten principles as policy (details on each principle follow below):

1) Recognize that our country faces a national public health emergency.

2) Direct increased resources for a lifespan of autism services through established services infrastructure at the state level.

3) Dedicate federal research to strategic research that can halt the autism epidemic in its tracks.

4) Conduct autism surveillance with the scope, timeliness and rigor appropriate to the need.

5) Focus strategic new research in areas that can yield meaningful near term results.

6) Keep individuals with autism safe from accidental death and injury.

7) Prevent harmful restraint and seclusion of autistic individuals.

8) Address critical gaps in vaccine safety research and policy governance.

9) End health insurance discrimination against individuals with autism.

10) Develop autism policy with an open, transparent approach.

We invite all organizations to mobilize and join in this vital effort. Contact information, an updated list of organizational members, and relevant documents can be found at CAACoalition.org.

The theme underlying all the Guiding Principles is that we need a legislative response driven by the seriousness of the epidemic, by the opportunity to prevent new cases and treat existing cases with the same urgency as our national response to hurricanes, floods, and pandemics, and by the necessity to provide adequate supports and services to facilitate people on the spectrum to lead full and complete lives. Accordingly, the first principle calls for the formal legislative recognition of the autism epidemic as a national health emergency without the usual hedging language from CDC that they don’t know how much of the increase is “real.”

The original Act was primarily focused on research with some additional funding for outreach and awareness education. It established the Interagency Autism Coordinating Committee (IACC) to advise the Secretary of HHS on all matters relating to autism and develop and update an annual strategic plan for autism-related research. CAA 2011 must restructure management of the research enterprise into a new National Institute for Autism Research, re-engineer the grant-making process to rapidly achieve the goals of prevention and treatment, and ensure vigorous and meaningful accountability, oversight, and broad community participation.

Research Funding Priorities Research funding must be re-prioritized and focused on the specific areas with the greatest payoff to achieve the goals of prevention and treatment. It is especially important that scarce research dollars be spent wisely in order to provide the greatest and quickest leverage. Accordingly, there must be a considerably greater focus on environmental factors, epigenetics, and on “translational” research that can quickly link bench science and clinical research to immediate medical and behavioral improvements. Money must be invested in research yielding the greatest benefit in the shortest time.

The legislative history of the original Act called specifically for research on vaccines as a potential cause of autism. However, despite repeated requests from across the community, ongoing compensation of vaccine-caused autism in Vaccine Court, recommendations and coordination from the National Vaccine Advisory Committee, and privately-funded research that continues to reveal damage done by vaccines to children and animals, IACC has refused to fund essential research such as a comprehensive comparison of vaccinated with unvaccinated children. CAA 2011 must specifically require a comprehensive program of vaccine safety research focusing on an ongoing comparison of vaccinated with unvaccinated children and animals and on the mechanisms of injury.

The CAA provided for research relating to services and supports but was not designed to actually fund them. Several bills have been introduced during recent sessions relating to demonstration projects and funding for services and supports, training, restraints and seclusion issues, wandering disorder, and infrastructure, but none of these has passed.

Especially in view of under-funding of existing mandates in Medicare and the aging of the leading edge of the epidemic through their teenage years and transitioning into adulthood, comprehensive legislation is needed to address – and fund – these complex issues. CAA 2011 must direct significantly increased resources for services through existing state-level infrastructure to the families and providers who are in the best position to meet the specific needs of individuals with autism. As with research governance, CAA 2011 must improve services governance by separating IACC into separate specialist committees that will be better able to focus on the quite distinct constituencies, specialties, and challenges faced in marshaling and coordinating the services-related resources throughout the federal government.

Because the urgency of the response and need will be aided by timely and accurate data on the scope and nature of the epidemic, CAA 2011 must significantly strengthen the gathering and reporting of information on the number of individuals with autism, the severity of their diagnoses, and their specific needs for services and interventions.

Individuals with autism face unique safety issues. Legislation must address these by guaranteeing that children in school enjoy a learning environment free from dangerous restraints and seclusion and by providing first-responder training and funding for systems to prevent wandering and ensure the safe return of children to appropriate supervision.

Legislation reforming various aspects of insurance has passed in over 20 states, and the recently passed national healthcare reform legislation addresses some aspects. However, in view of the strong popular support for “repeal and replacement,” CAA 2011 must provide for parity of coverage with other medical conditions and ban all forms of insurance discrimination arising from an autism diagnosis.

The reauthorized CAA must be the product of an open and transparent process. In the present toxic environment in Washington, its chances of passage will a strong community consensus on first, guiding principles, and then the details of policy implementation developed through a close collaboration of organizations that have disparate interests and objectives. Most important, passage will require an extraordinary effort in grassroots lobbying from throughout the community. In this election, and in preparation for the reauthorization effort, take the time to visit your local Representatives and Senators and educate them as to the urgent of the community for a comprehensive and coordinated policy response to the autism epidemic.

We invite all organizations to mobilize and join in this vital effort. Contact information, an updated list of organizational members, and relevant documents are at CAACoalition.org

Age of Autism
Autism Action Network
Autism One
The Autism Research Institute
The Autism Society of Connecticut
The Autism Society of Greater Phoenix
Elizabeth Birt Center for Autism Law and Advocacy
FoggyRock
Generation Rescue
Greater Brunswick Special Families
National Autism Association
SafeMinds
Talk About Curing Autism
The Pilot House

Thank you.

Missouri State Senate race turns personal over autism

(KMOX) — Claims made on a recent campaign flyer have blown up into a major issue between state Senate candidates Barbara Fraser and John Lamping.
They’re both vying for the seat being given up by Joan Bray, who’s being term-limited.

Fraser sent out a mailer saying Lamping was against health care coverage for children with autism.

Turns out Lamping’s 19-year-old daughter has a form of autism.

“Its amazing that my opponent says this is something that I’m running on,” says Lamping. “She’s fabricated this whole thing.”

To which Fraser replies, “Mr. Lamping proposal to let insurance companies sell policies across state lines would absolutely one-hundred percent allow insurance companies to deny coverage for autism.”

Listen to their full interviews with Charlie Brennan click here and go to the bottom of the next page.

NY Governor vetoes bill to mandate autism health-insurance coverage

Gov. David Paterson has vetoed legislation that would require state-regulated health-insurance companies to cover “evidence-based, peer-reviewed and clinically proven” treatment and therapy for people with autism spectrum disorder, saying it would amount to an unfunded mandate because it would increase health-insurance premiums state and local governments pay and the premiums for Child Health Plus, a government insurance program for children whose families are not eligible for Medicaid. The total annual cost of the legislation could be $70 million, according to the governor, and the state budget does not include money to pay for that.

The cost of commercial health insurance would also grow if the legislation were implemented, and could lead to loss of coverage for some New Yorkers, he said in the veto.

The state has a number of programs that provide early intervention for children with autism and other developmental disorders, although many families have to pay a significant amount of money each year to get all the services they believe their children need.

Paterson, who has about two months left in his term, wrote that he is “extremely sympathetic to the very real struggles faced by families of individuals” with autism spectrum disorder, which he said is a priority for society to address. Autism spectrum disorder, which occurs in roughly one out of every 100 kids, is characterized by difficulty with speech and social interaction and repetitive behavior patterns. Symptoms vary depending on where children are on the spectrum .

“It will be a subject of my continued advocacy as a private citizen. But now I am governor, and I cannot sign a bill that would impose costs that the Legislature does not fund,” Paterson wrote.

The bill has been the subject of intense lobbying by autism advocates who support and those who oppose the legislation. It was sponsored by Sen. Neil Breslin, D-Delmar, Albany County, and Assemblyman Joseph Morelle, D-Irondequoit, Monroe County.
Opponents said it would hurt people seeking treatment for autism because of the “evidence-based, clinically proven and peer-reviewed” standard, which is not required for other medical problems, and would shift costs from insurance companies to counties and taxpayers for early intervention services.

The governor said another flaw in the bill is it would require the state Health and Insurance departments and a few other state agencies to develop regulations for health insurers within a year and update them regularly, but the state budget does not provide them with the extra resources they would need to do this.”

Cost of Nevada autism care mandate debated

Oct. 07, 2010
Copyright © Las Vegas Review-Journal

By JENNIFER ROBISON
LAS VEGAS REVIEW-JOURNAL

DUANE PROKOP/LAS VEGAS REVIEW-JOURNAL

For a change, we're not going to talk politics today.

Sure, Nevada's autism health-insurance mandate became a red-hot campaign topic in September, with Senate Majority Leader Harry Reid, D-Nev., making a major issue of Republican candidate Sharron Angle's opposition to the pending requirement.

Rather than discuss the back-and-forth between the candidates and their affiliated interest groups, though, we want to ask a simple business question: How much will that autism regulation really cost, anyway?

A big Nevada insurer who didn't want to discuss the political hot potato on the record has crunched the numbers and found the mandate will add 2.2 percent, or about $100 a year, to Nevadans' annual premiums.

That's a "very significant impact," given that most new mandates add less than 1 percent to premium costs, said J.P. Wieske, executive director of the Council for Affordable Health Insurance in Alexandria, Va.

Autism's effect on insurance policies sold in Nevada will be steeper than usual because the condition costs so much to treat. A study from the Harvard School of Public Health found that autism care for one patient can run $72,000 a year. The Centers for Disease Control and Prevention estimates that just under 1 percent of the country, including 730,000 people up to age 21, battles an autism-spectrum disorder.

Nevada's mandate requires insurers selling policies in the state to cover up to $36,000 a year of autism-related care starting Jan. 1, though the state exempted its Medicaid program after officials found it would cost the program $30 million over two years for coverage of autism.

Those are big numbers, so naturally, autism advocates and insurance trade groups alike make potent economic appeals supporting their side. Mandate proponents acknowledge it costs to treat autism, but they argue it's more expensive to let autistic kids languish and end up institutionalized or on disability for life.

Ralph Toddre, a commissioner for the Nevada Commission on Autism Spectrum Disorders, pointed to studies that say it can cost millions over a lifetime to provide custodial care for autistic adults who lacked treatment as children. One study, from the Harvard School of Public Health, pegged the cost at $3.2 million, though Toddre said he's seen reports pushing the estimate to as much as $8 million.

"The bottom line is, you can pay for it now, or you can pay an awful lot more later if you don't treat it," said Toddre, who has two children, ages 12 and 9, with the condition.

And Jan Crandy, a Las Vegas advocate with a 17-year-old autistic daughter, took issue with the 2.2 percent premium impact. She said actuarial research developed in early 2009 to support the mandate forecasted a smaller premium effect of around 1 percent.

Wieske's council published a 2009 study that also set Nevada's autism premium impact at roughly 1 percent, but Wieske said the group is updating its numbers, because the council's initial assumptions didn't account for "explosions" in the number of autism diagnoses and the condition's care costs. He said he now believes the Nevada insurer's projection of a 2.2 percent premium impact is likely to be at least fairly close to the actual effect. The state's actuarial study also acknowledged that the future costs of some therapies were "uncertain" due to increased insurance coverage.

Assemblyman James Ohrenschall, D-Las Vegas, sponsored the mandate, which passed the Nevada Legislature 63-2. It likely won't be clear until 2011 just how much the mandate will cost, Ohrenschall said, but with thousands of kids statewide grappling with autism-related conditions, the Legislature needed to assist.

"The market was not helping these children," Ohrenschall said. "These are families who work very hard and pay a lot of money to have health insurance, and then it didn't cover what they needed."

But any noticeable premium jump could price some Nevadans out of health insurance altogether, Wieske said.

"We know from past studies that fewer people buy coverage as it becomes more expensive. It's the simple reality," Wieske said. "There's a balancing act there."

Susan Pisano, a spokeswoman for Washington, D.C.- based trade group America's Health Insurance Plans, said her association isn't concerned about the autism mandate itself. Rather, the organization's issue is with policy requirements in general, which she said typically become law without regard to their effects on health-care quality or costs. Nor do mandates always come from scientific evidence that certain treatments will help, she said.

The 50 states have passed 2,133 mandates on health insurers, according to Wieske's group. Nevada ranks No. 10 in the nation for its number of insurance mandates, with 52 such requirements.

"Over the last 20 years, we have seen the enactment of literally thousands of mandates across the country that have made the cost of coverage higher, and have put insurance coverage out of reach of more employers," Pisano said. "If you're a parent and you want services for your children, you're not going to be persuaded by that argument, but the other piece of this is that we've got consumers, patients and employers saying to us, 'If health-care costs continue to go up, we're not going to be able to afford what we have now."

Autism mandates in particular have grown popular among states in the past two to three years. Nearly half the states, 23, require insurers to cover it. Some of the surge comes from high-profile advocacy efforts in front of state legislatures, Wieske said, while part of the push involves sympathy for a condition that largely affects small kids. Plus, it's only been in recent years that doctors began to better understand autism and its treatments, he said.

But at least part of the jump in autism mandates originated with subtle attempts to shift the cost of care for the condition away from school budgets and into private insurance, Pisano said. Wieske agreed, noting that interventions such as speech therapy were typically covered through school districts and states, until widespread budget crunches pinched what the public sector could or would provide.

"It's absolutely true that we don't want to leave these children untreated," he said. "The question we have is whether insurance is the appropriate way to cover it. If these treatments were for an adult who had a stroke, you wouldn't find health insurance covering it. It might be covered under a long term-care policy. That's what this issue is really about -- money that was meant to be spent on (autism care) through various programs in schools is gone, so if they can, they want to foist those costs off onto insurers."

Advocates such as Toddre and Crandy say Nevadans are paying for autism care one way or another, and private health insurance provides the best venue for delivering treatment. More kids will be diagnosed with autism than with childhood cancers, juvenile diabetes and HIV combined, Toddre noted, yet insurance covers expenses for the latter three ailments.

"It's just not right. If there's an effective treatment out there that can help a lot of kids have a better quality of life and have a chance at a life as we know it, to deny that opportunity is just wrong," he said.

Besides, said Crandy, defraying the cost of pricey, unexpected conditions is the purpose of health coverage.

"A lot of people will never get cancer, and cancer treatment is expensive. That's what risk pools are for," she said. "Everybody is paying in so that everything that's covered can be treated."

Contact reporter Jennifer Robison at jrobison@review journal.com or 702-380-4512.

Michigan Parents Testify Before Lawmakers On Autism Coverage

Tuesday a panel of parents and experts testified before state lawmakers in an effort to help get Michigan to require health insurers to cover treatment for autism.

It is a disorder which affects socialization and learning for some 15,000 Michigan children. "Many children with autism will need special education for their entire school career, and will need institutionalization as adults if they don't get the treatment," said Lorri Unumb, Autism Speaks.

Treatment that for many families is a huge financial drain. "We've borrowed. I've financed from my retirement account, whatever it takes. It's something that you would almost sell your soul for. Almost," said Stacie Rulison who's son has autism.

Experts say treatment for autism works but it's expensive. They say it can cost tens of thousands of dollars a year. That's why parents and experts are trying to convince lawmakers Michigan should join 23 other states that require health insurers to cover autism treatment.

"Sometimes I will be talking with families who are informing me of their plans to leave our state to go to some other state where they can receive this treatment that is covered by insurance," said Ruth Anan, Autism Expert.

Experts say it's an investment that will push insurance costs up slightly, less than a dollar a month for every individual. But they say it's well worth the price to help children with autism.

"If they do get treatment many will go on to lead productive and independent lives," said Unumb. Tuesday's public hearing is the last of four on autism health insurance reform. Lawmakers say they'll use the information to draw up a report before considering legislation.

Court Ruling in autism case hailed as a breakthrough for insurance coverage

Editors note: During the 2009 Oklahoma Legislative Session, Rep Kris Steele, drafted legislation dubbed as the Republican Autism Plan to create an ABA research project at OUHSC. Autism advocates informed him that ABA has over 25+ years of clinical research and we do not need to spend hundreds of thousands of tax payer dollars to reinvent the wheel. This is nothing more than a stall. - Wayne

By Bryan Denson | OregonLive

For two years, Lisa McHenry fought a legal battle to force her insurer to pay for her son’s specialized autism therapy. But PacificSource Health Plans of Springfield refused and prevailed at every turn in court.

Then came a ruling this week by U.S. Magistrate Judge Janice M. Stewart in Portland, who ordered PacificSource to reimburse McHenry for the last eight months of her boy’s therapy.

“It’s the first decision in the country where a court has decided that ABA therapy (Applied Behavioral Analysis) is medically necessary for children with autism,” said Megan Glor, one of McHenry’s attorneys. “Insurance providers have been very reluctant to cover ABA therapy because it’s very expensive.”

The case offers a glimpse at opposing forces — insurers that won’t pay for the therapy and a nationwide parents movement pushing them to cover the disorder as a medical condition.

McHenry, who lives in Happy Valley, sued PacificSource in May 2008 to force the company to pay for her son Joe Joe’s therapy.

The case appeared to be resolved earlier this year, when Stewart ruled in favor of the insurer. The magistrate found that the boy’s therapist, Emily Hoyt, wasn’t an eligible provider under McHenry’s policy.

But in February, the state Department of Human Services certified Hoyt an eligible provider of therapy to Joe Joe, now 6.

On Tuesday, the judge ruled that PacificSource owed McHenry and her husband, Jon, their out-of-pocket expenses since then.

“Jon and I are absolutely over the moon. This is huge for Oregon,” Lisa McHenry said Wednesday. “This is huge for our family.”

Stewart ordered parties to the lawsuit to come up with a statement of past-due benefits.

Glor said she thinks PacificSource will be required to cover more than just the last eight months, but an additional $50,000 that the McHenrys paid for their son’s therapy from January 2007 to last February. A lawyer for PacificSource said the court has already ruled that the company doesn’t owe retroactive benefits.

“At the end of the day, the court said they don’t get any retroactive benefits,” said Richard Hansen. “She’s entitled to whatever costs she’s incurred since February, when the therapist became — under the court’s decision — an eligible provider.”

Source: http://www.oregonlive.com/happy-valley/index.ssf/2010/09/court_ruling_in_autism_case_hailed_as_breakthrough_for_insurance_coverage_of_special_therapy.html