Search This Blog

Sunday, January 4, 2015

Caps in Colorado

Nick Coltrain reports at The Coloradan about Colorado's insurance mandate:
Cari Brown knows her family is luckier than most that have a child on the autism spectrum.
Her 4-year-old son, Craig, was diagnosed early. While living in Utah, they “literally won the lottery” in having him selected for an intense therapy program. Seeing the night-and-day results prompted them to move to Fort Collins to take advantage of state insurance laws that mandate some level of coverage for autism treatments.
But not everyone has those opportunities, Brown realized, prompting her crusade to fix state law and remove the cap on how much treatment a child can receive. She calls it a “moral obligation” to help other families.
State Sen. John Kefalas, D-Fort Collins, raised her mantle and aims to carry a bill to that effect in the Legislature this year.
 Ken Winn, chief clinical officer at Firefly Autism in Denver, said the difference in results between children who are diagnosed early and receive the behavioral therapy they need and those who don’t is drastic. Those, like Craig, who are diagnosed and begin treatment by the time they are 3 years old have a 90 percent chance of recovery, he said. [NOT REMOTELY TRUE]
State law mandates insurers provide a minimum of $34,000 per year in coverage for children up to age 8; and $12,000 per year for those between ages 9 and 19. While the law specifies both of those amounts as minimums, most insurance companies don’t go beyond that, Winn said.
Even with the $34,000 minimum requirement, when dealing with young children recommended to have 40 hours a week in therapy, “you’ll hit that cap in a few months,” Winn said. When dealing with a lesser cap, as much therapy is focused on teaching the primary caregiver as it is working with the child — ironic, given the older one gets the tougher it is to break learned, socially unacceptable habits.
Kefalas’ bill would set the treatment coverage requirement for each child patient to what is deemed medically necessary based on the child’s diagnosis. Children at different levels of the autism spectrum would be given different levels of treatment, based on their needs.