Search This Blog

Monday, August 22, 2011

More on the CA Mandate Bill

An earlier post described SB 770, a California mandate bill. Michelle K. Wolf writes at The Jewish Journal of Greater Los Angeles
According to Marty Omoto, Director of the California Disability Community Action Network, there’s a very important piece of pending legislation in Sacramento authored by Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento, 6th State Senate District) that would require health managed care plans and health insurance plans to provide behavioral health treatment for persons with autism spectrum disorders as a covered benefit.
This bill, SB 770, would mandate coverage of behavioral health treatment, such as Applied Behavioral Analysis (ABA) and other intensive early intervention therapy, for thousands of people with autism spectrum disorders. The bill expands the list of qualified autism providers to include any licensed or nationally certified professional, or any provider of these services approved as a vendor by one of California’s 21 non-profit regional centers which contract with the Department of Developmental Services to provide or coordinate services and supports for individuals with developmental disabilities.

Sponsors of the bill include Autism Speaks, Alliance of California Autism Organizations, Special Needs Network, and The Help Group.

Steinberg is hoping to see SB 770 passed before the Legislature adjourns for their year on September 9th but the bill is expected to face fierce opposition from managed health care plans, who in the past have said that behavioral health treatments for autism should be provided by school districts and the state-funded regional centers. Naturally, both the school districts and regional centers expect for private insurance to pick up the tab. In the middle of this high stakes game of “eeny, meeny, miny, moe” are the parents of children diagnosed with Autism Spectrum Disorders, just trying to get funding for their child.
The Bay Citizen reports on the bill, noting the struggles of autism dad Kevin Epstein:
For years, health insurers and state agencies have battled over who should pay for behavior-based interventions for autistic children. Each tries to shift responsibility to the other. That has left a great number of families like the Epsteins without coverage.

Last month, two major insurance companies — Blue Shield of California and Anthem Blue Cross — agreed to reimburse initial costs for ABA, provided it is administered by a licensed analyst.

But California has no such licensing process.

“That’s like saying a nurse has to be licensed in giving you a flu shot, but there is no license for flu shot administering in California,” Epstein said. “The so-called agreement is a complete sham. The new bill is necessary to close the loopholes.”

Kristin Jacobson of the Alliance of California Autism Organizations, a proponent of the new bill, agreed that the settlement had “a fatal flaw,” despite being well-intentioned.

“It’s akin to denying chemotherapy for cancer or insulin for diabetics,” said Jacobson. “This is a well-recognized treatment and somehow health insurance companies have decided to deny it.”

By shifting financial responsibility to insurers, the bill, SB 770, would save the state between $100 to $200 million, according to Jacobson.

The California Association of Health Plans, the trade association representing the state’s insurance companies, opposes the bill, insisting that insurers already provide "comprehensive coverage for autism-related medical services."

"Treat it early, it's a small problem," Epstein, the father, said. "Treat it later, it's a big problem."

Epstein believes his son Elliott's ABA treatments were "worth every penny."

“Three years later, he is verbal. Although he’s hardly studying Shakespeare, he has basic communication,” Epstein said. “Without therapy, you wouldn’t have that. You’d have a 6-year-old looking like a 3-year-old."

But battling with insurance companies has taken a toll. Epstein said that to date, Blue Shield has reimbursed only a "nominal" amount.

“Every hour and dollar that I’ve spent having to go obtain the coverage that I thought I’d been paying for for two decades is hours that could have been spent with my son, could have been spent with my family, dollars that could have been spent providing him with a better quality of life,” he said. “When you’re stripping your house payment to pay for your son’s medical coverage, that can’t be good.”