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Sunday, November 18, 2018

The Autism Caucus Lost Many Members in This Cycle

In The Politics of Autism, I discuss the congressional role in the issue.

The Autism Caucus lost about one-fifth of its House members as a result of retirement, resignation, defeat, or election to other office.

Robert A. Brady (D) (Pennsylvania, District 01) retiring
Michael E Capuano (D) (Massachusetts, District 07) lost primay
Mike Coffman (R) (Colorado, District 06) lost general election
Barbara Comstock (R) (Virginia, District 10) lost general election
Ryan Costello (R) (Pennsylvania, District 06) retiring
Joseph Crowley (D) (New York, District 14) lost primary
John J Duncan Jr. (R) (Tennessee, District 02) retiring
Bob Goodlatte (R) (Virginia, District 06) retiring
Trey Gowdy (R) (South Carolina, District 04) retiring
Gene Green (D) (Texas, District 29) retiring
Darrell Issa (R) (California, District 49) retiring
Sander Levin (D) (Michigan, District 09) retiring
Jason Lewis (R) (Minnesota, District 02) lost general election
Frank LoBiondo (R) (New Jersey, District 02) retiring
Thomas MacArthur (R) (New Jersey, District 03) lost general election
Patrick Meehan (R) (Pennsylvania, District 05) resigned
Luke Messer (R) (Indiana, District 06) lost primary
Rick Nolan (D) (Minnesota, District 08) retiring
Erik Paulsen (R) (Minnesota, District 03) lost general election
Ileana Ros-Lehtinen (R) (Florida, District 27) retiring
Pete Sessions (R) (Texas, District 32) lost general election
Scott W Taylor (R) (Virginia, District 02) lost general election
Pat Tiberi (R) (Ohio, District 12) resigned
Tim Walz (D) (Minnesota, District 01) elected governor of Minnesota
Kevin Yoder (R) (Kansas, District 03) lost general election

In the Senate, Democrat Joe Donnelly of Indiana lost the general election

Kyrsten Sinema (D) (Arizona, District 09) left her House seat to run for the Senate, where she will probably remain in the Caucus.

Saturday, November 17, 2018

The West and the Antivax Movement

At The Conversation, Dr. Peter Hotez writes about the antivax movement.
Together with colleagues from Baylor College of Medicine and Texas Children’s Hospital, where I work, we did an in-depth study of kindergarten schoolchildren who receive vaccine exemptions across the country. Currently, 18 states allow nonmedical vaccine exemptions for either “conscientious objector” or “philosophical/personal belief” reasons. We were able to obtain information on 14 of those states.
A clear picture emerged: Vaccine exemptions are on the rise in 12 of the states we looked at. Indeed, anti-vaccine activities appear to be more of a western phenomenon, especially in the Pacific Northwest (Idaho, Oregon and Washington) and the American Southwest (Arizona, Missouri, Oklahoma, Texas and Utah).
What exactly is going on in the West, where many parents shun vaccines and take their children out of vaccination programs? Researchers are still at the early stages of understanding the reasons behind the anti-vaccine movement. A couple of these states, Oklahoma and Texas, host well-organized political action committees that lobby their legislatures and even raise campaign funds for candidates to endorse anti-vaccine positions. These committees appeal to parental fears of unwarranted government interference.
What’s more, some studies suggest that vaccine refusal is linked to affluence, and possibly with affluence there is greater access to the internet. There are now hundreds of anti-vaccine websites on the internet, many of which still allege that vaccines cause autism or that autism is a form of “vaccine injury,” neither of which is true.
The anti-vaccine movement also effectively uses social media to share their message. Some studies show that anti-vaccine social media has created an “echo chamber” effect that strongly reinforces negative attitudes towards vaccines.

Friday, November 16, 2018

Keeping All Students Safe Act

In The Politics of Autismdiscuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

A release from Senator Chris Murphy (D-CA):
U.S. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee, joined U.S. Representatives Don Beyer (VA-8) and Bobby Scott (VA-3), ranking member of the U.S. House of Representatives Committee on Education and the Workforce, and U.S. Senator Patty Murray (D-Wash.), ranking member of HELP, on Wednesday in introducing the Keeping All Students Safe Act to protect students from the dangers of seclusion and restraint at school.

The legislation would make it illegal for any school receiving taxpayer dollars to seclude children. The legislation also limits the use of physical restraint to instances when it is necessary for the safety of students and teachers. The bill would establish minimum safety standards in schools, require states to monitor the law’s implementation, and increase transparency and oversight to prevent future abuse of students.
The legislation refers to key facts and findings that reveal a concerning history of seclusion and restraint of students in schools, including a 2009 Government Accountability Office (GAO) investigation that revealed hundreds of incidents of child abuse in schools as a result of seclusion and restraint practices that disproportionately impacted children with disabilities and children of color.
FACT SHEET: Keeping All Students Safe Act
SECTION BY SECTION: Keeping All Students Safe Act

Thursday, November 15, 2018

Public Charge

In The Politics of Autism, I explain how the issue connects with so many other issues.  Immigration is an example.

Zaidee Stavely at EdSource:
Hundreds of thousands of immigrant parents in California may disenroll their children from health insurance, food stamps and other federally subsidized programs because they fear that receiving these benefits will make it impossible for them to become permanent residents in the United States.
Their fears have been triggered by new regulations proposed by the Trump administration that expand the number of benefits that immigration officers can take into account in deciding whether to deny an immigrant permanent residence in the United States. Federal law allows immigration officials to deny green cards to immigrants if authorities decide they are likely to become a “public charge” — someone who relies excessively on government benefits to survive.

The draft regulations are currently open for public comments until Dec. 10th.
Administrators at community clinics, school-based health centers and agencies serving children say some parents in California are already choosing not to enroll or withdrawing their children from health and nutrition programs.
A parent asked First 5 Alameda, an agency that supports families with small children, to stop seeking early intervention services from a local school district for their toddler with autism.

Wednesday, November 14, 2018

House Committees

The Autism Society explains how the switch to Democratic control will affect committees in the House of Representatives:
Budget and Appropriations
Rep. John Yarmuth of Kentucky will likely take the helm of the Budget Committee. This committee has jurisdiction over the budget resolution. The change likely means the budget will not be used to force changes to important programs like Medicaid, Medicare and Social Security. Yarmuth has said he hopes to mark up a fiscal 2020 budget resolution that will reflect Democratic spending priorities such as infrastructure, education, job training, and clean energy.
Rep. Nita Lowey of New York is slated to chair the powerful Appropriations Committee. This committee decides where the money allocated from the Budget Resolution will be used to fund specific programs. The Subcommittee on Labor, HHS, Education will be chaired by Rep. Rosa DeLauro of Connecticut. This committee has jurisdiction over spending decisions most autism and other disability programs.
Energy and Commerce/Health Care
Rep. Frank Pallone Jr. of New Jersey is in line to be the next chairman of the Energy and Commerce Committee currently led by Rep. Greg Walden of Oregon. This Committee works on important issues like health care, including Medicaid. Under the leadership of Pallone, the House will push back on any attempts to repeal the Affordable Care Act or to make cuts to Medicaid; and could introduce bills to strengthen the ACA marketplaces and begin reviewing bills to provide universal health care. Rep. Pallone is also the author of a bill to provide long-term care to seniors and people with disabilities that may now get attention by the committee. This committee will also be responsible for reauthorizing the Autism CARES Act, one of the Autism Society’s biggest priorities for 2019 when the law is set to expire.
Ways and Means
The Chairmanship of the Ways and Means Committee will likely be Richard Neil of Massachusetts. This committee is responsible for tax and some health care programs. It is unclear at this time what tax bills will be considered. On health, top priorities include shoring up the Affordable Care Act exchanges and lowering the cost of prescription drugs. The retirement of Rep. Sander M. Levin (D-MI), opens up the top spot on the Health Subcommittee. California Rep. Mike Thompson is currently the panel’s most senior member and likely to take that seat.
Education and the Workforce
Rep. Robert Scott of Virginia is expected to chair the Education and Workforce Committee. This committee will be responsible for the reauthorization of the Higher Education Act (HEA) and any other education and employment bills. Scott authored an HEA bill (AIM Higher Act) that would promote the inclusion of students with autism. This committee will also likely to take up a bill to reduce the use of restraints and seclusion in schools. Bipartisan bills in development related to increasing opportunities for competitive, integrated employment may also be considered in this committee in the new Congress. Rep. Virginia Foxx of North Carolina is expected to remain on the committee as the ranking minority member.
Judiciary Committee
Rep. Jerrold Nadler of New York is poised to become the next chairman of the Judiciary Committee. This committee has jurisdiction over our civil rights laws, including the Americans with Disabilities Act. Nadler was an opponent of HR 620, a bill that would weaken the ADA.

Tuesday, November 13, 2018

Insurance Billing Codes

The Politics of Autism includes an extensive discussion of insurance.

From Autism Speaks:
New CPT codes for ABA billing have been announced by the American Medical Association CPT Editorial Panel. These codes will take effect on January 1, 2019.
Autism Speaks has worked for multiple years on the CPT Steering Committee seeking AMA approval of these new codes. We are happy to join the committee in helping you understand and implement the new CPT codes for ABA services.

What are CPT codes?
Current Procedural Terminology (CPT) is a listing of terms and identifying codes used to report medical services and to bill insurance providers. CPT codes are issued and maintained by the American Medical Association (AMA).
CPT codes are classified either as Category I (permanent) or Category III (temporary).

How have the CPT codes changed?
ABA codes were first approved in 2013 and fell under Category III (temporary).
A workgroup was formed shortly after in order to revise the code set. The CPT Steering Committee included Autism Speaks, the Association for Behavior Analysis International, the Association of Professional Behavior Analysts, and the Behavior Analyst Certification Board.
            In the fall of 2018, the new codes for ABA billing were announced with important changes:
Eight new Category I CPT (permanent) codes for ABA services were approved.
Two Category III (temporary) codes were revised.
Blythe Bernhard at Disability Scoop:
“We expect that it will expand the types of services that insurance companies reimburse for,” said Wayne Fisher, director of the Center for Autism Spectrum Disorders at the University of Nebraska Medical Center and a member of the steering committee made up of representatives from various autism organizations that worked on the coding changes.
With the move, the medical association will recognize ABA as medically necessary under appropriate circumstances, Fisher said.

Monday, November 12, 2018

Antivax Movement in New York and Oklahoma

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Julia Belluz at Vox:
Anti-vaccine advocates have swayed parents in New York to refuse immunizations for their kids, sparking two of the largest measles outbreaks in the state’s recent history, according to local health officials.
As of Friday, 17 people in the neighborhoods of Williamsburg and Borough Park in New York City were confirmed with measles, along with 55 people in nearby Rockland County, for a total of 72 cases. Additional cases are currently under investigation, and the number is expected to rise.
What’s notable here is that all of the cases are occurring among unvaccinated or under-vaccinated Orthodox Jews, mainly children. When asked why people are opting out of vaccines, the city health department said anti-vaccine propagandists are distributing misinformation in the community.

The fearmongerers include the Brooklyn group called PEACH — or Parents Teaching and Advocating for Children’s Health — which spreads misinformation about vaccine safety, citing rabbis as authorities, through a hotline and magazines. Brooklyn Orthodox Rabbi William Handler has also been proclaiming the well-debunked link between the measles-mumps-rubella (MMR) vaccine and autism. Parents who “placate the gods of vaccination” are engaging in “child sacrifice,” he told Vox.
Last week, Republican Kevin Stitt won election as governor of Oklahoma.  In September, Sam Stein profiled him at The Daily Beast:
“I believe in choice,” Stitt said, “And we’ve got six children and we don’t vaccinate, we don’t do vaccinations on all of our children. So we definitely pick and choose which ones we’re gonna do. It’s gotta be up to the parents, we can never mandate that. I think there’s legislation right now that are trying to mandate that to go to public schools, it’s absolutely wrong. My wife was home schooled, I went to public schools, our kids go to Christian school, and that’s back to a parent’s choice.”

Stitt’s comments raise the specter that Oklahoma could water down immunization laws should he be elected the state’s governor this fall. They also place him within a growing fringe of politicians who have, in recent years, expressed skepticism over the prevalence of childhood vaccinations—a group that includes President Donald Trump himself.
“Kevin believes the topic of vaccinations is a serious decision that should be made by parents in consultation with their pediatricians,” said Donelle Harder, Stitt’s spokeswoman. She said that Stitt did not believe that vaccinations cause harmful medical side effects —an oft-argued and scientifically baseless claim from vaccine skeptics. The “root of his decision,” she said was the desire for parental choice
Such a position puts Stitt on the opposite side of public health advocates who have warned that immunizations must be a social contract in order to be medically effective. Anecdotal and scientific data has shown a direct correlation between vaccination hesitancy and the rise of diseases like measles.