Comments on: Florida’s “Window of Opportunity Act”

By: Shawn Lupella

Shawn Lupella — Thu, 22 May 2008 21:21:11 +0000

@ Maureen
If that is true–that the legislation passed in other states for autism basically “stands alone” thereby creating a distinct class or group (autistics), apart from the other classes or groups with similarly situated developmental conditions (like DS), then there lies the problem with the bill. We cannot differentiate based on a classification or specific diagnosis when the “degree of need” for treatment is the basically the same for both groups.

-tslupelli77@yahoo.com

By: Maureen

Maureen — Thu, 22 May 2008 17:13:17 +0000

@Shawn

1. These insurance bills are the first time that ABA is being covered for any condition, therefore in answer to your question this is not to add autism but rather to cover ABA for autism.
2. It is also very important to note that most states do not mandate coverage of OT, PT, or SLP for any conditions–even physical conditions that necessitate these services to increase or maintain ROM (range of motion), further many plans specifically exclude OT, PT, SLP for just that kind of coverage, therefore they only cover a set number 10-25 units per year in response to an acute incident (an accident/injury). Some states had begun requiring that insurance companies cover a set dollar amount ($5-10,000) for therapy during the birth to three age range (NH, MA and I believe VA) regardless of diagnosis. But most only state that if the policy covers OT, PT, SLP that early intervention could bill for reimbursement, but since most policies are written to address adults who have had an insult or injury the bills for early intervention services are routinely denied.
What we need is for all children with chronic health conditions and/or disabilities to have a portion of their therapy services covered by insurance–thus we have a three-legged chair: Family (premiums, co-pays, deductibles and additional), Government (early intervention, school-based, Medicaid, DDD…) and insurance. Unfortunately, children with autism are not the only children with disabilities who are not receiving assistance from the third leg.

By: Shawn Lupella

Shawn Lupella — Thu, 22 May 2008 15:29:13 +0000

I’m very interested as well–to compare and contrast the bills from other states. What I really want to know…Are these other conditions like DS, SB, CP, etc. already covered for ABA therapy in places like NJ–and now they are just trying to add autism to the list of already pre-approved conditions that qualify for the insurance-covered treatment?

By: Kristina Chew, PhD

Kristina Chew, PhD — Thu, 22 May 2008 05:42:42 +0000

@Shawn Lupella, Esq., Thank you—I’d like much to know what you find out and how your efforts proceed. Here in New Jersey there’s a bill before the assembly for insurance coverage of autism treatments and it helps a lot to know what other states have done. Very best—

By: Shawn Lupella, Esq.

Shawn Lupella, Esq. — Thu, 22 May 2008 04:05:17 +0000

Maureen, Kristina Chew PHD. Especially good points. The bill that passed is flawed and maybe unconstitutional. Autism should not have been the only group covered. Down Syndrome, Cerebral Palsy, Spina Bifida, etc. should have been part of this bill. I have already started working to try to figure out how to include these other groups. As an attorney and a father of a son with down syndrome, I feel called to the task. If anyone agrees-and wants to join in…let me know. If the legislature won’t take it up in the next session, I am prepared to litigate to make it happen.

By: Kristina Chew, PhD

Kristina Chew, PhD — Sun, 04 May 2008 00:38:56 +0000

@Ana,

We never received any coverage for behavioral therapy either. Music therapy—lessons—have really helped my son; definitely not covered by anyone. And, when our son was 7, we had to withdraw him from his public school classroom because things were not working out and we were concerned about his safety. Is he being homeschooled now—-and how is that working out? Very best—

By: Ana

Ana — Sat, 03 May 2008 23:55:24 +0000

Our son, a severely autistic 8-year-old, has never received coverage for behavioral therapy. Like other kids living with this horrendous disability, he would have also greatly benefited from music therapy and the neurofeedback (which are not covered by health insurances). In addition, we were recently pressured by his public school to withdraw him; which we did concerned about his overall safety. We enrolled him in home schooling, which we were told could be funded by the McKay Scholarship. However, this is very false. Neither they want him in school nor can we afford the high costs of educating him at home or of the therapies that are medically neccessary for him. It is very agonizing. There is just no compassion or willingness to help children like our son overcome this tragic disability.

By: Ana Herrera

Ana Herrera — Sat, 03 May 2008 22:39:16 +0000

If would be fair for health insurances to cover behavioral and music therapies and the neurofeedback. I have seen proof that these medical interventions are much more helpful to children with severe autism than others currently covered by insurances in Florida.

By: Regan

Regan — Wed, 23 Apr 2008 21:40:05 +0000

Excellent that it passed in the Senate. Hopefully it will go as smoothly in the House and the other bill will get out of committee.

From Florida.gov wesite
S2654 Steven Geller Autism Coverage Act”
passed Senate 4/23/08
yeas 30, Nays 0, Not voting 1
Now goes to FL House

HB1291 Still in Healthcare council committee

State Senate Bill 2654 — Autism Spectrum Disorder — has passed the appropriate committees and seems ready to be passed by the full Senate this year. The companion bill in the House, HB 1291, has 80 cosponsors. But because of Speaker Marco Rubio’s preference for the insurance industry, his biggest contributors, this bill has been waiting since April 2 to be scheduled before the Health Care Council.

By: Kristina Chew, PhD

Kristina Chew, PhD — Wed, 23 Apr 2008 21:02:50 +0000

Florida's bill passed:

The bill, named the “Steven Geller Autism Coverage Act” in honor of the Cooper City Democratic senator who's pushed it for nine years, says companies must provide coverage for therapies and other treatments needed to treat autism, but it excludes insurance plans offered by small employers. The child also must be diagnosed by 8 years of age or younger.